Drawings constitute a graphic expression of the child’s mental representation capacity. Through their drawings, children express their fears, anxieties and satisfactions in a symbolic way. They are particularly useful when the child does not use speech to communicate with the clinician. Drawings establish a language between the object (content of the drawing), the subject (child) and the observer (psychologist), while providing a visual support through which the child can show his fantasy world. The latter thus becomes real and tangible, without representing the concrete reality of the child. This article aims to show how drawings can be used in the context of children’s psychological assessment and psychotherapy. The drawings of a child with some psychotic vulnerabilities are presented and discussed in the light of some historical and contextual elements as well as his intrapsychic conflicts, anxieties and psychological resources. The authors also illustrate the therapeutic work concerning the child’s primitive anxieties of fragmentation, annihilation, and persecution uncovered in the child’s transference. Theoretical and clinical considerations regarding psychotherapy with children with psychotic personality organization are discussed.