Maybe she doesn't compliment patients on their looks--sometimes even a compliment can be trigger-y. (She liked my shirt yesterday, why not the new shirt today? etc)

My CBT T is a smart man-- as I work on my weight he is encouraging but never says that I look fitter or I've lost some pounds. He may talk about hard data like the number on the scale or my blood glucose levels. but never ever makes mention of how I look. In my case it may just be a guy thing, treading on eggshells! lol