The use of drugs during psychoanalysis as well as the psychoanalytical treatment of patients who need psychopharmacological medication raise a whole series of problems that are also the subject of controversial discussion. Nevertheless, the body of literature available on this topic is still quite small. Medication is invariably an outside parameter that is introduced into the psychoanalysis and it can cause a blind spot in the psychoanalytic treatment. On the other hand, as we are treating severely disturbed patients, we are confronted with a growing necessity to introduce medication into the psychoanalytic setting. The paper discusses the related conflicts of the psychoanalyst and shows in a case report how an analytic stance can go hand in hand with adequate medication. The paper argues that we have to accept the state of the art in psychiatry and at the same time continue to talk about medication in terms of psychological processes even though it poses a conflict and is also a threat to our narcissistic equilibrium.