Token-economy programmes with chronic psychotic patients: The importance of direct measurement and objective evaluation for long-term maintenance

Direct-observational data collected from 6 example patients over 5 yr on a token-economy ward are presented. Comparison of performance in baseline, contingent-token and non-contingent-token conditions revealed considerable variability within and between both patients and self-care behaviours. For 3 patients the Token-Economy Programme appeared to have a ‘therapeutic’ effect, producing behaviour change that was sustained after the termination of a contingent token regime. For the others, rates of behaviour change were exceptionally slow and the token economy functioned as an essential prosthetic environment. It is suggested that the longevity of the system was related to the conceptional framework and methodology employed. An example of behaviour becoming ‘token bound’ is included.