Hello, I am Dr Alberto Pertusa. I have worked as a consultant psychiatrist for nearly 10 years. I work in as a Catholic hospital and I also have a private practice in Central London. Well, as a general adult psychiatrist, I see patients with all types of problems, including common problems such as stress, anxiety or depression, as well as bipolar disorder, sleeping problems, eating disorders, alcohol problems or other types of addictions, OCD, body dysmorphic disorder, ADHD, autism. However, my clinical experience as some of my clients do not really fit into any particular diagnostic category. So my approach is to always try to understand the person as a whole rather than necessarily focusing on any particular diagnostic labels. Well, the initial consultation is particularly important in terms of starting to build a solid therapeutic relationship with a client. During the first appointment, I explore the nature of the client's problems using a gentle approach. Now, the idea is to work with a client in order to create that space where the client can feel comfortable and safe, telling me how they feel, talking to me about their problems, sometimes even about their fears. Now, in my experience, this can take some time and that is why it always allows for one and a half hours for a first appointment. So I can make sure that we've had enough time to go through a comprehensive assessment, explore treatment options. I also find that this gives the client enough time to go through any questions they may have or to discuss any particular issues. The idea is that by the end of the first consultation the client and I will have agreed on a treatment plan. Now, in order to design the treatment plan, I start by explaining all possible treatment options and by asking the client how they feel about each of these options because I need to feel confident that the client is happy with the treatment plan before we agree on it. I always like to explore all potential treatment options with the client and that includes obviously medication but also psychotherapy, psychoeducation, counseling, all lifestyle changes for instance. Now, for me to prescribe or suggest a certain medication to a particular client, I need to be very confident that that client is going to benefit from that medication. Every medication has got pros and cons so my approach is to always discuss these with the client to make sure we make that decision jointly. On the other hand, I also have a number of clients who are not keen to take medication. So in these cases, what we do is we explore collaboratively with the client all other possible treatment options and I must say that in many of these cases it's possible to find a non-pharmacological approach that will make a difference for the client. In some other cases we may decide to leave medication as a plan B and perhaps start a different treatment and see how it works and just use medication if necessary at a later stage during the treatment. At the end of the first consultation, if we have agreed that the client would benefit from a follow-up appointment, we will agree on a suitable follow-up schedule. If I have prescribed any medication, I will definitely ask the client to let me know within a few days if they feel that medication is working for them or if they have any particular side effects. In between appointments, some clients find it helpful to send me an email or have a telephone conversation to let me know how things are going or if they have any particular issues to discuss. However, every client is unique and I do my best to tailor my approach to the specific client's needs and wishes. Well, for those who have never seen a psychiatrist before, I would tell them that going to the psychiatrist should be a positive experience where you feel listened to and above all empowered and I would also encourage them to think about it as an opportunity for change and personal improvement.