BACKGROUND:
Afghan refugees who have resettled in the U.S. face substantial barriers when accessing culturally appropriate mental health care.1 Cross-cultural communication challenges—including but not limited to idioms of distress, divergent illness explanatory models, collectivist versus individualist orientations, and authority dynamics—threaten therapeutic alliance formation.1,2,3 While existing cultural frameworks like the Cultural Formulation Interview support assessment and initial rapport-building, there is a need for structured guidance for sustained cross-cultural therapeutic communication throughout treatment.4.5,6 This study proposes Dr. David Victor's LESCANT framework (Language, Environment and Technology, Social Organization, Context, Authority, Nonverbal, Time)7,8 as a systematic framework for analyzing cross-cultural therapeutic communication with Afghan refugee populations.

METHODS:
Semi-structured qualitative interviews with 9-12 U.S.-trained mental health clinicians (masters-level or higher) who are Dari/Pashto-speaking and provide therapy to Afghan refugees. Operational definitions derived from LESCANT's seven domains guide interview protocol and thematic analysis. MAXQDA software facilitates coding; intercoder reliability assessed via Cohen's Kappa. Analysis will identify cross-cultural communication barriers across LESCANT domains. Expected

RESULTS:
This methodological approach will map observable cross-cultural communication dynamics to specific domains, enabling identification of: language barriers beyond translation (idioms of distress, somatic expressions); environmental and technological factors (post-migration stressors, war trauma); social organization influences (collectivism, gender norms, family involvement); contextual communication patterns (indirect communication, stigma); authority perceptions (roles of providers or structural assumptions); nonverbal cross-cultural communication differences; and temporal orientations affecting treatment engagement.

CONCLUSIONS:
LESCANT will provide structured guidance for clinicians navigating cross-cultural communication in mental health settings with Afghan refugees. This framework will address critical gaps in existing cultural formulation models by offering actionable, domain-specific cross-cultural communication strategies. Findings will inform alliance building and areas in which Western models of therapeutic interventions and rapport may need to be addressed or adapted, as well as delivery of culturally responsive mental health services for refugee populations globally.