Narrative Matters: Drawing the diagnosis - shaping the truth in communicating acute lymphoblastic leukaemia in paediatric oncology.

Communicating a diagnosis of acute lymphoblastic leukaemia in paediatric oncology represents a critical and emotionally charged moment, one that shapes the child's and family's relationship with care from the outset. From a psychodynamic and psychoanalytic perspective, this moment cannot be reduced to the transmission of medical information alone, but constitutes the initiation of a caring relationship in which issues of trust, meaning and emotional containment are immediately at stake. This paper describes and reflects upon a clinically grounded communicative practice developed within a paediatric oncology setting, in which a 'shared drawing' is used as a mediating tool when explaining the diagnosis to children. Drawing is conceptualised as a potential space in Winnicott's sense, allowing medical reality to become thinkable, approachable and emotionally tolerable without being denied or trivialised. Through the co-construction of a simple visual narrative, the paediatric oncologist and psychologist help the child engage with the experience of illness while preserving the child's subjective position and emotional agency. A brief clinical vignette illustrates how this approach may support emotional regulation, understanding and the early formation of a therapeutic alliance. The paper proposes that shared drawing is not a standardised technique but a relational device, whose clinical value lies in the quality of presence, containment and attunement offered within the communicative encounter.