Erica Lubliner is a psychiatrist at the University of California, Los Angeles, who directs a clinic that offers mental-health services to Latinos. She provides care to a wide range of patients: first- to fourth-generation immigrants, including undocumented immigrants, and undergraduate and graduate students at U.C.L.A., many of whom are the first in their families to go to college. She usually meets patients in her bright office on campus in Westwood, where paintings by Mexican artists hang on the walls and children’s books are within easy reach. But, after the ICE raids began around the city last month, she moved her appointments online. Lubliner’s patients are safe in her clinic, she told me, “but even getting here can be scary.”

She had heard that ICE agents had started parking outside some local hospitals. Many of her patients take the bus or walk to their appointments, and they worry that they might get apprehended on the way. “It’s not wise for them to leave their homes, because ICE agents have been circling and patrolling neighborhoods,” she said. Many of her patients have increased their doses of anti-anxiety medication, or have started taking it for the first time. Some young patients experience intense separation anxiety when they go to school, afraid that they’ll return home and their parents will be gone. Many adults ask friends and family to buy groceries for them, or to walk their kids to school.

After ICE arrested people at their places of work, Lubliner sensed her patients’ anguish. “ICE is going after the gardener with his truck, the workers at the car wash. The idea that they are somehow dangerous cuts at their identity in a deep way,” she told me. “They feel unwanted. They feel targeted.” Some of her less vulnerable patients participated in protests against the raids, but others struggled with whether to take the risk. “They feel guilty for not participating, and they feel helpless, and they feel afraid, but they also feel that it’s important to speak out because silence is not the answer, either,” she added.

Lubliner is one of several psychiatrists and psychologists I recently spoke with who have worked with immigrant patients for many years. They’re familiar with the psychological harm caused by past law-enforcement crackdowns and anti-immigrant rhetoric. But, as Dana Rusch, a psychologist at the University of Illinois Chicago and the director of an immigrant mental-health program, told me, “This feels different than it did during the first Trump Administration. It feels different than other periods of immigration enforcement, even prior to the Trump Administration. What’s happening right now feels humanistically different.” Her younger patients are asking her why people hate immigrants so much, or hate them and their families. Rusch said that she has a hard time answering these questions. (Her typical response is to talk about oppression in an age-appropriate way.)

Lubliner has also seen the increased emotional toll that this latest round of raids has had on her patients. During the first Trump Administration, she was doing her fellowship in child and adolescent psychiatry, and she witnessed plenty of fear. “Some of the kids were worried—there was some school avoidance. . . . People were afraid to go to doctor’s appointments,” she told me. “But right now people are trapped in their homes. It’s very different. Children are now having conversations with parents about what Plan B and Plan C are if they get deported. They’re going to notaries public to write down what will happen to their children.” One of her patients is so afraid to go outside that she won’t throw out her trash, so she has a neighbor help her. “People are being grabbed off the streets, and their family members don’t know where they’re being taken,” Lubliner said. “There’s a level of terror I haven’t seen before.”

For many of these patients, their fears recall past traumas: from their home countries, their journeys to the United States, and their settlement. Those who have memories of their lives in Latin America have reported experiences of extreme poverty, abuse from family members, or discrimination because they’re Indigenous. Many who recall their journeys north remember being exposed to extreme violence: murders, physical and sexual assault, kidnappings, extortion, and forced labor. “They’re forced to work in exchange for food and shelter, or they’re told that they have to work for a certain period of time in order to gain passage to the next stop on the route,” Rusch told me. “That’s true of the unaccompanied minors, but it’s also true of families who’ve made the journey together.”

Then they arrive in this country, where the threat of deportation hangs over them. Many kids experience difficulty in school, and many adults are underemployed. Food may be scarce. They hear Trump Administration officials saying that all of them are criminals and that many of them are violent.

As patients sit in her office, Rusch told me, they can sometimes recognize that they’re safe, at least compared with earlier moments. But their experiences haunt them. They have a tough time trusting people. “Those are very normal responses to what you’ve been through,” she tells them. They had to be constantly alert as they were trying to get from Central America to Mexico on foot. Now they feel the same, she said, “in a country they don’t know, where people speak a language they don’t understand, and where their status is precarious.”

Rusch’s patients have conditions that she diagnoses as trauma and depression, but she wants to help them understand where the anxiety comes from. “My patients say, ‘Oh, I have trouble paying attention. I can’t start and stop my tasks. I’m just not a motivated person.’ I’m, like, ‘No, that’s trauma, that’s anxiety, that’s depression,’ ” she said. “I always tell them that this is a normal response to extraordinary circumstances. If I’m assessing someone for suicidality, I ask, ‘Do you ever wish you would fall asleep and not wake up?’ That’s one of the first questions. Some say yes.” She also pointed out that the standard methods used to assess suicide risk may not be as effective for patients who are dealing with this kind of trauma: “Even the concept of how we assess risk is in some ways out of context, because they’re, like, ‘Yeah, I’ve had suicidal thoughts for three years because of what I’ve been through.’ ”

Rusch said that many of her patients don’t want to address their traumas. Instead, they want to talk about “the ways they can feel empowered in their day-to-day lives”: how they can get work authorization, acquire skills in a particular trade, learn English, prepare to answer questions from immigration lawyers, or earn money to send to relatives back home, which can be difficult for some to feel good about if their family neglected or abused them.

This makes sense to Rusch. “If you don’t have food, shelter, and safety, it’s hard to talk about the higher-order safety of psychological health,” she told me. “It’s not that one is less important, but it’s hard to jump from one floor to the next without stairs.” For this reason, cognitive behavioral therapy, or C.B.T., is one of the preferred methods for treating trauma-induced anxiety among immigrants and their families. This method aims to help patients distinguish between real and imagined fears, and, to the extent that their fears are imagined, it helps patients learn to reframe them. It’s more about problem-solving than psychoanalysis.

But the fears of immigrants are as real now as they’ve ever been. Families are being separated. Immigrants with legal status are being deported. Citizens are being unlawfully detained. As Lubliner put it to me, “At this point, just being Latino is a risk factor.” Therapists still use C.B.T. to treat their patients, but the fears and anxieties of patients like the ones Lubliner and Rusch see require modified approaches.

One of Lubliner’s patients is a woman whose husband was in the process of securing legal status. But, when he showed up to immigration court for a mandatory check-in, he was detained and deported. They have three children, and she’s taking care of them by herself. She hasn’t been able to sleep, and she has started taking anti-anxiety medication. Lubliner has also started providing psychiatric care for her children, whose teachers were concerned about their behavior in school and their inability to focus. Lubliner told me that this kind of case management, which goes far beyond regular therapy sessions, is common right now. Jenny Zhen-Duan, an assistant professor at Harvard Medical School and a psychologist at Massachusetts General Hospital, said she, too, has been doing “more case management than usual” for immigrant patients, extending her care to “connecting patients with legal services, mutual aid, and information about their rights.”

The therapists I spoke with said that they encourage their patients to confront their fears directly, and they work with them to come up with a plan for what to do if the worst comes to pass. How will they respond if they are detained or deported? Who can children contact if they are separated from their parents? Where will family members try to meet up again? These conversations can be difficult, but they can also help patients gain a sense of agency, the feeling that there are at least some things they can control. “I back off when needed,” Lubliner said, “and I’m always aware that, as a representative of the medical field, I am mending past breaches of trust at the hands of the health-care system.”

Lubliner also tries to help her patients by putting them in shared spaces with others. She runs a group session called La Plática, where Spanish speakers can discuss their experiences with one another. Because their stories are often similar, Lubliner said, they tell each other things like “Yes, what you’re saying is very true, and your fear, your anger, is valid.”

In these sessions, Lubliner tries to “concentrate on practical things, like how to get yourself out of fight-or-flight mode, because when we’re stressed we can’t think—there’s constant rumination.” Participants meditate. They breathe together, which, she says, doesn’t come naturally to many of her patients because it feels to them like being idle. She encourages prayer as a form of mindfulness, and sometimes they just sigh together, which she described as a kind of collective complaint.