Shared decision-making (SDM) offers a model for prescribers and patients to arrive at treatment decisions in a collaborative way. SDM in psychiatry holds out the promise to better honor our patients’ autonomy in a field which historically has failed to honor or has even oppressed it. At the same time, psychiatric prescribers who incorporate SDM in their practices should not forget their crucial roles as educators and advisers, especially for patients whose decision-making may be compromised. In this chapter, we will review the core principles of SDM as they apply to psychiatric prescribing, discuss potential benefits and pitfalls, and provide vignette examples of SDM in practice.