Introduction

Qualitative research is widely recognized in the field of human sciences as relevant and fruitful, as it allows the production of comprehensive knowledge via various theoreticalmethodological frameworks that are linked to different epistemological paradigms (^{Denzin, & Lincoln, 2017}). Although this type of investigation can be conducted with the study of different materials, interviewing participants remains a widely used procedure, as this allows the researcher to actively participate in the process of producing the research material itself. Thus, efforts aimed at improving the conduct of interviews are justified, enabling them to generate relevant and meaningful communications in a relaxed and playful environment, which drastically reduces the risk of discomfort or damage, momentary or lasting, among the participants. One of the ways in which the interviews can be improved is by replacing the socalled triggering or guiding question, which explicitly informs the participant about the research interest (^{Andrade, & Cury, 2021}), with the use of mediating resources that motivate the production of imaginative associations from via the suggestion of a theme. Thus, there is an incentive to abandon rationally and discursively elaborated manifestations in favour of the invention of narrative and concrete responses. Therefore, the research problem must be addressed indirectly, whereby “talking about” is replaced by an imaginative focus on a situation that referring to the interest of the researcher, is defined according to concrete designs, such as imagining “a person who is taking university entrance exams”, “a person who has lost a family member to Covid”, “a person who has won tickets and accommodations for a visit to Africa” or “a user of public mental health services”. Thus, manifestations that are merely theoretical and/or politically correct, which hide beliefs and fantasies, not always conscious, and whose character can be hostile, discriminatory and prejudiced, can be maximally avoided.

The Thematic Drawing-and-Story Procedure (PDE-T)⁴ is one of the mediating resources around which psychological interviews can be articulated. Developed by ^{Aiello-Vaisberg (2020)}, based on the Drawing-Story Procedure (D-E) of ^{Trinca (1976)}, these procedures bear an undeniable similarity to projective techniques but have often been used as resources that paradigmatically follow the Winnicottian Squiggle Game (^{Winnicott, 1968/1989}). On the other hand, both lend themselves, as demonstrated by ^{Tardivo (2020)}, to different forms of interpretation, thus harmonizing with other theoretical orientations.

The D-E, defined by ^{Trinca (1976)} as an investigative technique, was introduced in 1972 as an intermediate instrument between unstructured psychological interviews and graphic and thematic projective tests for clinical and research purposes. It requires the examinee to complete five sequential units of free drawings and five stories associated with them immediately after each of the former, followed by a “survey” and a title. Consisting of a slightly different proposal, the PDE-T consists of requesting the participants in the research to make a thematic drawing and then to invent a story about what was drawn to understand their nonconscious affective-emotional positions on a variety of human situations. While the Trinca and Aiello-Vaisberg procedures have been used as methodological resources in a variety of studies in Brazil, a surprisingly similar technique known as Draw and Write or Draw, Write and Tell has been used as a methodological resource in research with children. In a literature review on this technique, ^{Angell, Alexander and Hunt (2015)} point out that the idea of “drawing, writing and telling” was pioneered in 1972 by Noreen Wetton, who thereby facilitated emotional communication with children. Thus, ^{Wetton (1999)} has used the abilities of children to illustrate their own feelings and emotions through drawings and stories, compensating for their difficulties articulating their emotional experiences discursively. Since then, a large number of publications in English, usually within the health field, have studied children using this technique. Interestingly, the initiatives of Wetton and Trinca, practically simultaneously occurred without, apparently, one having any notion of the other’s work. While the D-E has been widely used in the psychological approach to individual personalities, as demonstrated by its extensive literature (^{Trinca, & Brito, 2020}), the PDE-T aims to identify and understand how groups of people, that is, collective personalities, position themselves affectively and emotionally in relation to various human conditions and situations, such as giving up a child for adoption, being the mother of a child diagnosed as autistic, being a successful woman or having formed a homoparental family. Therefore, it does not seek to obtain an in-depth view of the unique and individual way of being of each participant but rather to identify the 1) beliefs and fantasies that circulate in their social environment and 2) affective-emotional determinants underlying these beliefs and fantasies. The PDE-T was born in the context of the psychoanalytic study of collective imaginaries, a concept that soon replaced the so-called psychodynamics of social representations (^{Aiello-Vaisberg, 2020}). Its use remained restricted, for some time, to qualitative research based on the psychoanalytic method from the perspective of concrete psychoanalytic psychology (^{Bleger, 1963/2018}), a reference that is part of the relational psychoanalytic approach (^{Kuchuck, 2021}; ^{Liberman, 2014}). In this vein, it has been linked to the methodological recommendations of ^{Herrmann (2001)}, an author who has forged a sufficiently clear psychoanalytic interpretive operation through three watchwords: “let it emerge”, “take into account” and “complete the configuration of meaning”. However, qualitative researchers who work with other theoreticalmethodological frameworks have used the PDE-T, justifying the investigation of studies that have used this mediator resource of the psychological interview and the knowledge already produced thereby. Thus, this study aims, through a literature review, to synthesize and analyse scientific production, specifically, articles using the Thematic Drawing-and-Story Procedure, with a view towards improving interviews in the qualitative field.

Method

The present study is methodologically organized as an integrative review, corresponding, therefore, to a specific type of bibliographic study of a systematic and orderly nature characterized by the use of a guiding question via which a comprehensive view of previous studies can be obtained (^{Mendes, Silveira, & Galvão, 2008}; ^{Broome, 2000}). Specifically, it focuses on the use of a methodological resource, seeking to answer the following question: “How is the current scientific production that makes use of the Thematic Drawing-and-Story Procedure characterized?”

Based on the steps that characterize integrative reviews regarding the location, selection and analysis of articles, we consulted the following databases: 1) Electronic Journals in Psychology (PePSIC); 2) Scientific Electronic Library Online - Brazil (SciELO- Brasil); 3) Latin American and Caribbean Health Sciences Literature (LILACS); and 4) The United States National Library of Medicine (PubMed). PePSIC aims to contribute to the visibility of psychological and scientific knowledge generated in Latin American countries and was chosen here because the PDE-T was originally developed for research in the field of psychology. SciELO-Brasil, which has a transdisciplinary nature, was included because the mediator resource in question can be used in research conducted outside the field of psychology. The LILACS platform covers the health area where the presence of psychological research is expressive. Finally, querying the PubMed platform is justified because it is a search engine with free access to the MEDLINE database, which includes citations and abstracts of research articles in biomedicine in journals across more than 70 countries, covering research developed in and around the world outside Brazil. It is also worth noting that these four platforms provide open access to full-text articles published in journals of recognized scientific quality. Using the descriptors “Procedimento de Desenhos-Estórias com Tema”, “Procedimento de Desenho-Estória com Tema”, “Thematic Drawing-and-Story Procedure” and “Thematic Story-Drawing Procedure”, we established the following inclusion criteria for articles: a) published between 2017 and 2023; b) a complete article; and c) demonstrates the use of PDE-T as a resource in the production of empirical material. The corpus obtained via the application of these criteria was assessed independently by two evaluators, generating results organized into six analytical dimensions aligned with the guiding question as follows: 1) objectives, i.e., the terms of the life issues addressed and the basic concepts used; 2) number and type of participants; 3) procedure for producing the research material; 4) PDE-T analysis procedure; 5) discussion of the results and 6) knowledge area. These searches were performed in September 2023.

Results

In the first survey, before applying the criterion relative to the year of publication, we obtained a total of 210 studies. After excluding productions prior to 2017, duplicates, theoretical articles and articles lacking an effectively use of the PDE-T, we determined 25 articles eligible for analysis. Figure 1 shows the flowchart for the search and selection of articles to provide a visualization of the steps taken in determining the productions that should be included in the present study.

Figure 1 Flowchart of the Search and Selection of Articles 

Table 1 lists the twenty-four selected artidimensions through which we aim to answer the guicles with relevant information on four analytical ding question.

Concerning the objectives in terms of the life issues addressed and the basic concepts used, we have confronted a picture that draws attention for its richness and diversity. With regard to the life problems, announced in the objectives of these articles in the research corpus, we observed a wide variety. Thus, we found studies related to motherhood, childcare, female double shifts, gender issues, stages of development, the practices of health professionals or experiences in situations of illness and hospitalization, etc., and studies related to health problems. Regarding the basic concepts used, we found 11 studies that have applied the concept of collective imagination and 14 based on the following concepts: experiences, understandings, perceptions, emotions, expectations, and conceptions. While the concept of the collective imaginary is always defined and explicitly linked to the psychoanalytic framework, the others are only sometimes linked to the psychoanalytic framework (^{Silva, Sei, & Vieira, 2023}; ^{Costa et al., 2021}; Gil, Lima, Carvalho, & Medeiros, 2021; Budzyn, & Oliveira, 2020; ^{Costa et al., 2020}; Rotella, Nascimento, Camargo, & Nogueira, 2020; ^{Silva, Sei, & Ortolan, 2019}). At times they are clearly not psychoanalytic, but they fail to explain their reference (^{Fonseca, Panciera, & Zihlmann, 2021}; Machado, Carvalho, Paranhos, & Costa, 2020; ^{Vale, Alves, & Carvalho, 2020}; ^{Freitas, Campos, & Gil, 2017}; ^{Oliveira, Carvalho, & Rodrigues, 2017}; Silva, Moura, Albuquerque, Reichert, & Collet, 2017) or adopt the humanist framework (^{França et al., 2018}). Regarding the next focal topic, namely, the number and type of participants, we observed some heterogeneity with regard to the ages, numbers and characteristics more or less directly linked to the investigated question. The number of participants varied greatly, with 1 study involving 48 respondents, 1 study having 30 participants, 14 having between 11 and 18 participants, and 9 studies including fewer than 10 participants. There are several age groups into which the participants have been distributed, as we found, in the set of productions studied, children, adolescents, adults and elderly individuals. Furthermore, attention should be given to the fact that in general, the interviewees have been very close to the human problem being addressed. Thus, 19 studies dealt with participants who had the studied condition, whether they were patients, adolescents, elderly individuals, caregivers or athletes; 5 studies addressed participants who professionally dealt with the focal life problem, and 1 study included participants who may have the focal problem addressed in the future. Regarding the procedures for the production of research material, 17 studies were based exclusively on material generated by the use of the PDE-T, while only 8 studies used other instruments to produce research material in addition to the PDE-T, such as the D-E, therapeutic consultations, focus group, field journals, Piagetian tests, Free Word Association Test (FWAT) and Paediatric Quality of Life Inventory (^{Costa et al., 2021}; ^{Fonseca et al., 2021}; ^{Costa et al., 2020}; ^{Machado et al., 2020}; ^{Rotella et al., 2020}; ^{Vale et al., 2020}; ^{França et al., 2018}; ^{Silva et al., 2017}). Regarding the procedures for analyzing the PDE-T, the set of articles studied here presented two forms of treatment: psychoanalytic interpretation and thematic analysis. This is a very important point due to their methodological interest. Psychoanalytic interpretation, the product of the correct use of the psychoanalytic method, corresponds to the establishment of hypotheses about what remains outside the field of consciousness and exerts significant effects on human acts. Thus, we found that 11 articles in the studied corpus have adopted this form of treatment. In addition, since thematic analysis consists of the consideration of the themes that constitute what is manifestly expressed in the research material, which may or may not be later read in light of psychoanalytic theories, 14 articles in the studied corpus adopted this treatment of the research material. Within these two possibilities of analyzing material, that is, psychoanalytic interpretation and thematic analysis, we distinguished subtypes, a fact that is of undeniable methodological interest. Thus, psychoanalytic interpretation has been used in two ways: 1) adopting the watchwords of ^{Herrmann (2001)} (^{Fonseca-Inacarato, Gallo-Belluzzo, & Aiello-Vaisberg, 2023}; Fabris- Zavaglia, Visintin, & Aiello-Vaisberg, 2022; Batoni, Schulte, Gallo-Belluzzo, & Aiello- Vaisberg, 2021; ^{Kopanakis, Silva, & Aiello-Vaisberg, 2021}; ^{Ferreira-Teixeira, Visintin, & Aiello-Vaisberg, 2019}; ^{Manna, Leite, & Aiello-Vaisberg, 2018}; Gallo-Belluzzo, Ferreira- Teixeira, & Aiello-Vaisberg, 2017) and 2) performing free inspection of the material (^{Peres, 2021}; ^{Rosa, Lima & Peres, 2021}; Lima, Rosa, Cordeiro, & Peres, 2021; ^{Rosa, Lima, Miranda, & Peres, 2021}). On the other hand, thematic analysis has been initiated according to two possibilities already established in the literature: 1) using empirical categories (^{Silva et al., 2023}; ^{Fonseca et al., 2021}; ^{Gil et al., 2021}; ^{Costa et al., 2021}; ^{Costa et al., 2020}; ^{Machado et al., 2020}; Budzyn, & Oliveira, 2020; ^{Rotella et al., 2020}; ^{Vale et al., 2020}; ^{Silva et al., 2019}; França et al. al, 2018; ^{Freitas et al., 2017}; ^{Silva et al., 2017}) or 2) using theoretical categories (^{Oliveira et al., 2017}). For instance, the latter article evaluated the material in the light of previously established categories based on Elizabeth Kübler-Ross’s theory of grief. The discussions of the results obtained in these studies that compose the corpus studied here clearly reflect the types of treatment given to the research material, that is, whether they have offered psychoanalytic interpretations or thematic analyses. Those who adopted psychoanalytic interpretations of the research material achieved similar results, which support the validity of prejudiced imaginaries with respect to the focal life issues. Other results obtained by these researchers via thematic analyses have remained less convergent than those of the first group. Among the studies in this set, we found 13 that addressed themes related to the health area whose participants had diagnoses of various chronic physical diseases or problems related to their mental health. These studies can be divided into three sets, according to the results discussed: 1) those that point out the relevance of the environment in both favouring coping with the focal disease and treatment, minimizing suffering, as well as in hindering the performance of treatment and increasing the suffering of the chronically ill, whereby the environment is also deemed responsible for the focal problems and emotional distress when people experience prejudice, conflicting relationships or a lack of reception (^{Gil et al., 2021}; ^{Costa et al., 2021}; ^{Costa et al., 2020}; ^{Vale et al., 2020}; ^{Silva et al., 2017}); 2) studies that indicate the suffering of chronic patients is due to routine treatment (^{Silva et al., 2023}; ^{Fonseca et al., 2021}; ^{Machado et al., 2020}; ^{Rotella et al., 2020}; Budzyn, & Oliveira, 2020; France et al., 2018; ^{Oliveira et al., 2017}); and 3) a study that concludes on the importance and effectiveness of a new intervention modality, as a welcoming space for patients awaiting care at a psychology schoolservice clinic (Silva et al., 2019). Regarding the research that addresses a theme in the social area, namely, work expectations during old age (^{Freitas et al., 2017}), these results indicate the existence of prejudiced social representations of old age, similar to the set of studies that has applied psychoanalytic interpretation in its treatment of research material. Finally, with regard to the field of knowledge within which the focal research was produced we found 17 studies within the field of psychology (^{Fonseca-Inacarato et al., 2023}; ^{Silva et al., 2023}; ^{Fabris-Zavaglia et al., 2022}; ^{Batoni et al., 2021}; ^{Peres, 2021}; ^{Rosa, Lima, & Peres, 2021}; ^{Lima et al., 2021}; ^{Rosa, Lima, Miranda, & Peres, 2021}; ^{Kopanakis et al., 2021}; ^{Fonseca et al., 2021}; ^{Gil et al., 2021}; Budzyn, & Oliveira, 2020; ^{Ferreira-Teixeira et al., 2019}; ^{Silva et al., 2019}; ^{Manna et al., 2018}; ^{Gallo-Belluzzo et al., 2017}; ^{Freitas et al., 2017}), 6 in the field of nursing (^{Costa et al., 2021}; ^{Machado et al., 2020}; ^{Vale et al., 2020}; ^{França et al., 2018}; ^{Silva et al., 2017}; ^{Oliveira et al., 2017}), 1 in the field of medicine (^{Rotella et al., 2020}), and 1 study that arguably belongs to two areas, psychology and nursing (^{Costa et al., 2020}). The fact that most of these articles were published in the psychological field was to be expected due to the very origin of the instrument. The remaining studies were conducted in a health area, namely, nursing or medicine. Notably, some authors applied PDE-T as a projective technique (^{Fonseca et al., 2021}; ^{Machado et al., 2020}; ^{Rotella et al., 2020}; Vale et al.; 2020; ^{França et al., 2018}; ^{Oliveira et al., 2017}; ^{Silva et al., 2017}).

Discussion

Based on the results of the present review, although PDE-T was created in the context of the psychoanalytic study of collective imaginaries, qualitative researchers who work within other theoretical-methodological frameworks have successfully used this mediator resource, thereby increasing its value as an investigative resource. In this case, it has often been applied in thematic analysis, which, as we know, aims to objectively and systematically describe the manifest content of participants’ communication through the identification and analysis of figurative or verbal patterns (^{Freitas et al., 2017}). Emphasizing the fundamentally flexible nature of thematic analyses, ^{Braun and Clarke (2006)} have also affirmed the possibility of its articulation with different comprehensive approaches, either as the only way of treating the material or as a stage that prepares the formulation of psychoanalytic interpretations. Thus, they have clearly demonstrated the affinity between psychoanalytic and nonpsychoanalytic comprehensive approaches. The possibility of applying different analysis procedures of PDE-T among researchers who adopt the psychoanalytic method and those who use thematic analysis has been observed. This has attracted increased interest from qualitative researchers applying different approaches in theoretical-methodological studies. We also found diversity in the types of populations investigated, indicating that the PDE-T is a resource that facilitates interviews with children, adolescents, adults and elderly individuals with different levels of education and various health conditions. Thus, the PDE-T can be used in various research contexts. The list of topics already studied is wide, which points to the versatility of the instrument, i.e., how it is valued for favouring the expression of deeper aspects and not just the conscious and rational aspects of the participants. Another dimension analysed, the number of participants, has revealed how this resource has been used in qualitative studies with a varied number of participants, from 4 to 48. The PDE-T is therefore a very useful procedure in collective interviews with a large number of participants. Under these conditions, researchers ask their group of participants to draw a picture according to the proposed theme and then to write a story; finally, they ask them to express their views on the focal lived experience, which is then shared between the group of participants and researchers. In regard to participants who are illiterate or have difficulty writing, such a story is verbalized by the participants and then annotated by the researchers. Therefore, there are several ways of producing empirical material, with different conditions of participants, increasing the usefulness of the PDE-T as an investigative resource. As the PDE-T was developed by a psychologist/psychoanalyst, it was to be expected that most of the focal articles would have authors from the psychological field, but a significant number of these studies were conducted by nurses and physicians. Notably, the use of PDE-T by researchers without previous training in psychology is absolutely legitimate because, despite appearances, it is not a psychological test but a procedure that facilitates the manifestation of participant-based research. In addition, the intention to perform a clinical activity, such as an individual psychodiagnosis, is in no way at stake. Thus, the use of the PDE-T in research by nonpsychologists does not violate the regulation of this professional practice. On the other hand, the resource has also attracted the attention of health professionals, which indicates that it may be of interest to researchers who perform so-called clinical-qualitative studies, well developed and established by ^{Turato (2011)}.

In general, the results of the analysed studies constitute important contributions to society, to professionals and to the various social movements that work with studied groups, specifically, because they consider the psychological and social aspects that are part of every human being and that have been, traditionally and often, explored in qualitative research.

Final Considerations

The present investigation indicates that the interest of researchers adopting a qualitative approach in the PDE-T has increased in recent years. This is an interview mediating resource initially used by psychologists/psychoanalysts but undergoing a significant increase in its use by researchers applying other theoretical-methodological approaches and in other areas of knowledge. The fact that well-qualified journals have accepted for publication both studies that make use of the PDE-T, according to the modality idealized by ^{Aiello-Vaisberg (2020)}, and others that adopting it from other theoretical perspectives, has given rise to a production that can be considered expressive. Thus, there is a body of knowledge that affirms that the PDE-T is an important and promising interview mediator in the field of qualitative research. On the other hand, the PDE-T has been restricted to studies conducted by Brazilian researchers. We believe that the growing trend of such articles being published in English in journals in the fields of psychology and health may favour the dissemination of this resource among researchers in other countries. Future research should therefore verify the confluence points and possible differences between the PDE-T and the Draw and Write and Draw, Write and Tell techniques (^{Angell et al., 2015}), as a considerable volume of research has been conducted with both.