The Empty Chair
She was always on time. Maria — let's call her that, though it isn't her real name — sat in the same chair for eleven sessions straight. She talked about her mother in Port-au-Prince, the way she worried about her younger brother's school fees, the guilt that followed her like a shadow no matter how far she'd walked from Haiti. She cried in session four. She laughed in session seven. By session eleven, she was beginning to plan things again — a job interview at a community college, maybe enrolling in a certification program.
Then she stopped showing up.
No cancellation call. No text. Just an empty chair and a missed appointment that kept missing.
I asked her therapist — a good clinician, trauma-informed, bilingual — what might be going on. The therapist listed the usual suspects: avoidance, resistance, maybe a flare of depression. But something about that explanation felt thin. Because Maria wasn't avoiding this conversation. She was engaged. She was investing.
What if the answer had nothing to do with therapy at all?
What if it had everything to do with a Supreme Court ruling handed down three weeks before her last session?
The Legal Shock
On June 26, 2026, the U.S. Supreme Court ruled 6-3 in Mullin v. Doe that the Trump administration's termination of Temporary Protected Status for Haitians and Syrians was valid. Justice Elena Kagan, in dissent, wrote that "hundreds of thousands of Haitians and Syrians living in this country will lose their legal status and work authorization" (p. 12).
For context: as of March 2025, approximately 330,735 Haitians held TPS — a statutory designation that lets nationals of certain countries remain temporarily in the U.S. when conditions at home make return unsafe or impracticable (KFF). Combined Haiti and Syria terminations could impact roughly 334,000 immigrants (KFF).
TPS holders lose work authorization. They become at risk for deportation. And the ruling doesn't just affect TPS holders themselves — many have U.S.-born children who are citizens, spouses with mixed status, employers who depend on them. Some families face an impossible calculus: stay together and risk returning to dangerous conditions, or split up and endure separation (Barsky 2026).
For Maria, the ruling didn't arrive as abstract policy. It arrived as a door closing.
The Psychology of Fear
People living under the threat of deportation experience heightened anxiety, depression, trauma-related symptoms, family stress, and substance abuse (Gutierrez & Silverio, 2026; cited in Barsky 2026). The loss of TPS creates cascading uncertainty — about housing, employment, healthcare access, education for children, family unity, and personal safety.
But here's what the research makes chillingly clear: this isn't generalized anxiety. It's specific. A study by Yamanis et al. (2024) published in PMC found that fear of deportation produces chronic anxiety and drives individuals to manage that fear through vigilance — behaviors that restrict movement, limit social network engagement, and avoid institutional contact (Yamanis et al. 2024). Higher deportation-fear scores significantly predicted avoiding healthcare (p = 0.007).
The KFF 2025 Survey of Immigrants found that 77% of undocumented immigrants report negative health impacts from immigration-related worries, and 48% avoided seeking medical care due to immigration concerns (KFF).
Think about that number. Nearly half. People who are sick, who need help, who want help — and they stay away because the cost of showing up feels higher than the cost of suffering in silence.
This is what García (2018), cited in Yamanis et al., describes as deportation threats functioning as both chronic and anticipatory stressors that restrict movement and participation in social life. The fear isn't just what might happen tomorrow. It's the weight of maybe — every day, all day.
Why Therapy Specifically Suffers
Here's where most clinicians get it wrong. They assume that if a client was engaged in therapy before the policy change, they'll remain engaged after. But therapy isn't just another appointment on a calendar. It requires three things that become dangerous under TPS termination:
Showing up at an institution. A therapist's office is a building. It has a sign. It may have other patients checking in. For someone who's now undocumented, entering an institutional setting increases perceived risk of immigration enforcement or surveillance (Barsky 2026).
Disclosing personal information. TPS-affected clients may fear that records — even therapy notes — could be accessed by immigration authorities. Yamanis et al. found that undocumented immigrants avoid health services specifically because they mistrust that medical records won't be used against them (Yamanis et al. 2024).
Maintaining a routine. When your entire existence has been reorganized around survival — checking news for policy updates, avoiding certain areas, preparing contingency plans — the luxury of a weekly therapy session becomes impossible. Not because the work isn't valuable, but because survival takes cognitive bandwidth that therapy simply can't compete with.
Mixed-status families face an additional layer: the painful dilemma of whether staying together as a family means returning to dangerous conditions, or splitting up and enduring separation (Barsky 2026). Maria may have stopped coming because she was making a choice her therapist never asked about.
The vanishing client isn't disengaged. She's surviving.
What Clinicians Can Actually Do
The research is surprisingly concrete about what helps. Barsky (2026) outlines several evidence-informed approaches that go far beyond "be more culturally sensitive":
Name the elephant. Be explicit about confidentiality, its limits, record-keeping practices, and the specific steps you take to protect client privacy. Not as a legal disclaimer — as a genuine conversation. TPS-affected clients need to know, concretely, what happens to their information (Barsky 2026).
Ask, don't assume. Offer services in settings clients experience as safe. Secure telehealth may help some; others prefer in-person services in locations that feel less visible (Barsky 2026). For some, an immigrant-serving community center feels supportive. For others, it feels too risky. Ask the client what setting, format, language, and communication method would feel safest (Barsky 2026).
Provide trauma-informed, culturally appropriate care that supports safety and dignity (Barsky 2026). This isn't a buzzword checklist — it means recognizing that the political reality these clients are living through is itself a trauma exposure, and treatment must account for that.
Link with qualified immigration attorneys and civil rights organizations (Barsky 2026). Clinicians can't resolve immigration status, but they can become familiar with referral sources — immigrant aid agencies that offer legal advice (Barsky 2026).
Help clients prepare emotionally for legal consultations. Organize their thoughts, identify support persons to attend with them, manage anxiety before and after legal appointments. With informed consent, provide letters documenting psychological symptoms, trauma history, family impact, or treatment needs (Barsky 2026).
Re-engagement Without Pressure
If Maria's chair is still empty, here's what I'd suggest — grounded in the research, not intuition:
Reach out. Not with a demand for explanation, but with a simple message: I noticed you weren't able to make our last session. I'm here when you're ready, and we can figure out what format works for you right now. No guilt. No clinical language about "dropout" or "non-compliance." Just an open door.
Understand that her silence isn't rejection. It's the behavioral manifestation of a fear system that has been activated by something far larger than therapy. Yamanis et al.'s finding that deportation fear drives vigilance and restricted social engagement (Yamanis et al. 2024) tells us that avoidance in this context is adaptive — it's the brain trying to keep someone safe.
Meet her where she is. If she responds, offer options: a phone call instead of an in-person session. A text check-in. A meeting at a location she chooses. The goal isn't to get her back into the same chair — it's to preserve the therapeutic relationship through whatever form it can take right now.
Acknowledge the political reality without giving legal advice. You don't need to be an immigration expert. You just need to say: I know what happened with the TPS ruling. I know this is affecting your life in ways that make therapy feel risky or impossible right now. That makes sense.
The termination of TPS for Haitian and Syrian migrants is not only a legal and political issue — it's a mental health and family stability issue (Barsky 2026). Clinicians who understand this won't be confused when clients vanish. They'll recognize the pattern. And they'll leave the door open.