Use of a token economy with seriously mentally ill patients: criticisms and misconceptions

Although use of a token economy has been shown to have significant impact on adults and children with serious mental illness who participate in inpatient and community treatment programs, the intervention has not been widely adopted. The paper presents common criticisms of token economies, which may explain the infrequent use of this treatment strategy. They include perceptions that token economies are ineffective, that their benefits do not readily generalize to other settings, that token economies do not foster individualized treatment plans, that participating in a token economy is humiliating, that token economies are abusive, that concerns about milieu management are unimportant and irrelevant to treatment delivery in the 1990s, and that effective token economies are impractical. In an effort to rekindle interest in this potent treatment technique, the author shows that many of these criticisms rest on misconceptions and provides rebuttals based on empirical research. He describes three steps in establishing a token economy.