Affective distress has been a double-edged sword in psychoanalytic treatment. Motivation for treatment develops when emotional discomfort reaches a threshold of intolerable pain. When distress rises above a certain limit, the patient becomes flooded and overwhelmed by affects that severely compromise his/her capability of utilizing psychoanalytic treatment. The psychoanalytic therapist's dilemma has been whether prescribing medication facilitates treatment or undermines and/or distorts treatment with destructive consequences. The efficacy of combining pharmacotherapy and psychoanalytic therapy is more firmly validated by recent studies. The focus shifts now toward the indications, and contraindications, for integrated treatment. An essential issue remaining is whether, and when, the treating analyst should be the prescribing analyst.