THE TOKEN ECONOMY

Read the scenario carefully.Once you have read it answer thequestions at the end of the scenario.Present this assignment in a paper format, not question/answer, as though you were doing an evaluation of the program.The answers to each question should consist of a minimum of one well thought out paragraph. Support your responses with material from the textbook and additional references as appropriate.

160 CHAPTER 7 ACTIVITY 7.1 Having worked as a therapist for a number of years, Jim Forrest had developed a high level of expertise in dealing with problems related to substance abuse. His work had included jobs in several settings, including a short-term detoxification program in a hospital, a community-based methadone treatment center, and a community mental health outpatient program. Although his work with clients had always been satisfying, two things continued to trouble him. One major issue for Forrest was that his experience had convinced him that his clients' milieu was more important than any other aspect of treatment. Although one-to-one counseling could be helpful, it was always less important than the reinforcement clients got for various behaviors in their immediate social environments. The other aspect of his work that tended to trou- ble him was the question of management. As a pro- fessional therapist, he had grown impatient with the pressure on him to stick to specific time lines and methods regardless of his clients' needs. In each agency, managers tended to create methods of oper- ation based more on business principles and treat- ment costs than on the effects of various treatment modalities. Forrest felt that given the chance to do what he felt was best for his clients, he could work both effectively and efficiently. Forrest finally had the chance to try out his ideas when he was invited by a former colleague to take on a job as head of a newly funded detoxification pro- gram being set up in one wing of the local community mental health center. The program had been funded to provide short-term services, and two of the thera- pists from the previous, smaller program were to remain on staff. With this exception, Jim would be free to develop the program in whatever way he saw fit. Funding was sufficient to provide for the hiring of a staff of four more professional therapists and eight paraprofessionals. Forrest began interviewing potential employees, telling each of them the same thing. The program would be based on use of a token economy, meaning that clients would receive concrete and specific rein- forcements for behaviors that were consistent with responsible, adult conduct. Every staff member would need to be involved in recording and reinforcing THE TokeN EcoNnomy appropriate client behaviors, for only then would the clients begin to learn new ways of dealing with their environment. Beyond this \"bottom line of commitment to the token economy as a treatment modality, professionals would be free to set their own hours and work with clients according to their best interests. Newcomers would be more closely supervised at first. Later they, too, might have the kind of freedom already granted to the experienced professionals. Most of the new workers started in at their tasks with a high degree of enthusiasm. It was like a dream come true, and after a few weeks, Forrest began to think that he was already secing results in terms of client change. A few problems, however, were begin- ning to surface. First, Hugh Schmidt, one of the two therapists who had already been employed at the center, began to complain to anyone who would listen about the idea of the token economy. Schmidt believed that long-term therapy, insight, and intrapsychic change were the only ways to deal with substance abusers. Changes in behavior could not get at the root cause of the problem, and the token economy could change only concrete behavior, nort attitudes. He continued to work with clients in the same way he always had, but the token economy was constantly being sabotaged. Another member of the professional staff was troubled not by the token economy but by the free- dom Forrest allowed the employees. Carol Cooke pointed out that although the staff members had been enthusiastic at first, they would not maintain a high level of commitment unless they were aware of the rules and regulations governing their own behaviors. Forrest scoffed at these concerns until one Friday afternoon when he had to make a presentation at an out-of-town conference. When he realized he had forgotten something, he called the office. Not one of the professional staff members was there. The problems Forrest had begun to face were minor, but they started to make him think. Could he maintain a central focus in the program if every member of the professional staff were not necessarily committed to it? Could he trust the professional staff in the way he had always wished to be trusted? The BunpinG SupeErvISORY RELATIONSHIPS 161 challenges began to seem a little more difficult than team, or is there room for a great deal of he had expected. variation? 3. What would you do about the problem Carol Cooke poses? Do employeeseven trained professionalsneed clearer behavioral guidelines than Forrest provided? Do you think Forrest has the potential to be more effective than the business-oriented profes- sional managers he had encountered before? 1. What do you think of Jim Forrest's approach to the position of program administration? What are his strengths and weaknesses in dealing with his new leadership position? 4 2. If you were Forrest, what would you do about ' the problem Hugh Schmidt's attitude poses? Is it necessary for the staff to work as a closely knit