Shared Decision Making in Psychiatry: What It Is and Why It’s Important for Care
What Is Shared Decision Making?
Shared decision making (SDM) is a collaborative approach to care where the clinician and the patient make treatment decisions together. It’s a real conversation, not a one-way handoff.
It brings together two things:
Clinical evidence: What does the research say about the available options?
Your values and preferences: What matters to you in your daily life, and what tradeoffs are you willing to make?
Both are required. One without the other is incomplete care. And in my practice, I treat them as equally important.
Why This Matters More in Psychiatry Than Almost Any Other Specialty
Shared decision making exists across all of medicine, but I believe it is especially essential in psychiatric care. Here's why I feel so strongly about it.
Psychiatric treatment is personal by nature
Choosing treamtent in psychiatry involves understanding how a medication or therapy approach fits into your actual life: your schedule, your priorities, your relationships, what you're hoping to feel like. That context lives with you, not in a research paper.
I can bring the evidence and expertise. You bring the knowledge of your own life. A good treatment decision needs both.
There is rarely one objectively "correct" treatment
Unlike some areas of medicine where one treatment clearly outperforms the rest, psychiatry often involves multiple reasonable options with different benefit and side effect profiles. Two people sitting in my office with the same diagnosis may thrive on entirely different medications, therapy approaches, or combinations of both.
Your input is clinically necessary.
Feeling heard predicts better outcomes
The research supports this, and so does my own experience: patients who feel involved in their treatment decisions are far more likely to follow through with their care plan. One of the most common reasons people stop psychiatric medications within the first year is that the medication was chosen without enough conversation about what mattered to them. SDM addresses this directly.
What Shared Decision Making Actually Looks Like
When I sit down with a patient to talk through a treatment decision, I try to make sure we cover four things together:
1. All the options I walk through what's available, including the option of waiting or doing nothing, rather than jumping straight to a recommendation. You deserve to know the full picture.
2. Honest tradeoffs We talk through the benefits, risks, and unknowns of each option. I'll always tell you where the evidence is strong and where it's limited. I'd rather acknowledge uncertainty than project false confidence.
3. What matters to you This is the part I find most important. I ask about your priorities. Are you concerned about side effects? Planning a pregnancy? Trying to stay sharp for a demanding job? Your answers genuinely shape my recommendation.
4. A plan we both feel good about We leave with a treatment plan that reflects both clinical judgment and your personal values, one you feel ownership over, because that's what actually leads to follow-through.
For Patients: Questions Worth Asking Your Psychiatrist
Whether you see me or another psychiatrist, I want you to walk into every psychiatric appointment knowing you are allowed to ask questions. Here are some worth bringing:
What are all the treatment options for what I'm experiencing?
What does the research say, and where is the evidence limited?
What are the most common side effects, and how would we manage them?
What does waiting or doing nothing look like?
What would you recommend, and why?
How will we know if this is working?
What happens if I want to stop or change course?
A physician who practices shared decision making will welcome every single one of these.
What to Do If Your Care Doesn't Feel Like a Partnership
If your appointments feel one-sided, if decisions are being made for you without explanation or input, that's worth discussing. You can invite a different kind of conversation by simply asking: "Can you walk me through my options?" or "What would happen if we waited on this?"
If that still doesn't change things, it may be worth considering whether the physician fit is right for you. You deserve a psychiatrist who is genuinely listening.
The Bottom Line
Shared decision making comes down to something simple: you are the expert on your own life, and your psychiatric care should reflect that.
Good treatment is both clinically sound and something you can realistically live with. Getting there requires your voice in the room. That's always been true in how I practice and continues to be.
