Taking Charge of Your Own Mental Health

Jul 11
5 min read

Shared Decision Making in Psychotherapy

Who is making the decision?

Maybe you’ve experienced this: You’ve just left a consultation, holding a treatment plan or a form in your hand, and you’re feeling unsure. Did you really understand all of this? Were there alternatives to the planned course of action? And were you really asked for your opinion? Or was the decision made for you while you sat there?

This uncertainty isn’t pleasant. And it’s common.

In psychotherapy, it shouldn’t be that way. Mutual dialogue and the therapeutic relationship are the foundation of psychotherapeutic work. Yet genuine joint decisions aren’t a given, even when there’s a lot of discussion between you and your therapist.

What is Shared Decision Making?

There is a technical term for this: shared decision making. It is the subject of my doctoral dissertation and my research, and it continues to shape the way I work to this day.

In somatic medicine, this approach is considered the gold standard of good clinical practice nowadays. The World Health Organization also explicitly recommends it for psychotherapeutic work.

Shared Decision Making means more than just "talking to each other” or “asking what the other person wants.” It is a concept based on an underlyind mindset: self-determination and autonomy for patients, and a treatment on equal footing.

The basic idea is simple: In every treatment, two types of knowledge come together. There is the professional knowledge of the healthcare provider: theories, methods, and clinical experience. And then there is your knowledge: knowledge about your life, your values, and your preferences. About what has worked well for you in the past, and about what is feasible and manageable for you in your everyday life.

Both are necessary. The best decisions arise from the collaboration between clinical expertise and your personal desires and needs.

Why is Shared Decision Making particularly important in psychotherapy?

Psychotherapy has certain unique characteristics that make shared decision making especially important.

Psychotherapy often provides support over extended periods of time
The experience of psychological distress is deeply individual: Two people with the same diagnosis may experience things very differently and have very different needs
There are many decisions to make: Which goal should we pursue first? Which issues should we address, and which should we set aside for now? Which method should we use? What happens inbetween sessions?

These questions cannot be answered solely from a professional perspective. They require your perspective.

What Shared Decision Making can achieve

Research in this area is most advanced in somatic medicine. There, shared decision making's benefits are well documented:

People are better informed about what is troubling them and about treatment options
Both patients and healthcare providers are more satisfied with the outcome
Treatment plans are more likely to be followed because they are truly the patient’s

The last point is perhaps the most important. People are more likely to follow a path they’ve helped choose themselves than one someone else has chosen for them. And in psychotherapy, that’s ultimately what it’s all about: taking personal responsibility and implementing changes in one’s own daily life.

An important point to add: Not everyone wants the same thing

There’s another nuance that’s often overlooked. And it’s particularly important to me. The positive effects of shared decision making are most evident when the desired level of participation aligns with the level actually experienced.

Not everyone wants the same level of involvement. Some people want to make every decision themselves. Others want to be guided. Still others want to hand over decision making entirely - because they’re exhausted, because they lack a sense of security, or because it feels good to be able to lean on someone else for a while.

All of this is legitimate. And all of this can change over the course of treatment. Someone who initially wants to be supported during an acute crisis may very well want to have a say a few months later.

There is no “right” level of involvement that applies to everyone.

That’s why shared decision making isn’t about assigning the same level of responsibility to everyone. It’s about asking what you need and about you aktually saying it.

What This Means for You

You have a say in the decision making process. And you have the right ask for it.

Specifically, this can mean:

Asking why a particular approach is being taken and whether there are alternatives
Mentioning that you feel a topic is being addressed too early or that you’d like to move forward more quickly
Asking for more information if something is unclear to you
Mentioning a specific method that you’d like to work with

You’re also allowed to say that you don’t want to decide everything on your own right now. That, too, is a form of participation.

And you’re allowed to ask what happens next - and have a say in where things are headed.

None of this is rude. It’s the foundation of care that’s truly yours.

Aus meiner Sicht ist es unsere Aufgabe, nicht darauf zu warten, dass Menschen sich von alleine beteiligen, sondern sie aktiv dazu einzuladen und den Wusch zur Beteiligung oder Zurückhaltung zu respektieren. Es geht darum zu erfragen:

Wie viel möchten Sie mitentscheiden?
Wie viel Information ist hilfreich, und ab wann wird es zu viel?
Womit möchten Sie heute arbeiten?
Was brauchen Sie gerade: Orientierung oder Freiraum?

Eine Therapie ist kein Plan, den jemand für Sie ausfüllt.

Sie ist ein Weg, den zwei Menschen gemeinsam gehen.

Ich kenne als Therapeutin das Gelände. Ich kann Empfehlungen aussprechen und Wege vorschlagen. Aber die Richtung bestimmen Sie mit.

What I Can Contribute as a Therapist

From my perspective, our role as therapists is not to wait for people to participate on their own, but to actively invite them to do so and to respect their desire to participate or to hold back.

It’s about asking:

How much do you want to be involved in decision making?
How much information is helpful, and at what point does it become too much?
What would you like to work on today?
What do you need right now: guidance or space?

Therapy isn’t a plan that someone else fills out for you.

It’s a journey that two people take together.

As a therapist, I know the terrain. I can offer recommendations and suggest paths. But you help determine the direction.

Conclusion

Taking charge of your own mental health doesn’t mean doing everything on your own. It means taking the lead in making decisions about your own life.

It means being consulted. Being informed. Being allowed to disagree. And having a say in what happens next. Even when you want support.

Perhaps you’ve recognized yourself in some of these points. Perhaps you’re looking for a therapeutic process that you can actively help shape. If so, I’d like to encourage you to voice your wishes. At my practice in Frankfurt or during an initial online consultation, we can get started together: at your own pace, with your questions, and with as much say in the process as you’d like.