A patient we'll call David came for a consultation seeking help regarding a mood disorder.  Variously diagnosed as depression or anxiety - or both, it had plagued him for most of his adult life.   Most of his emotions seemed tied up with his working.  As a middle aged professional who ran his own small firm, he placed a great deal of pressure on himself to perform up to his own high standards and easily fell into despair about what he perceived as his professional inadequacies.