I would like to be offered a tissue. From my perspective, it's just the considerate thing to do. It doesn't make me feel silenced or pushed. If I offer someone a tissue, it is not because I have a need for them to stop crying or am uncomfortable but because of how I myself prefer to be treated when crying. I want to preserve some dignity and that's hard to do with tears and snot running down my face. For someone to just sit there feels like it sends the message that what I'm doing is inappropriate and I should stop ASAP since my tears don't even warrant an offer of a tissue.

I'm not saying other people are wrong to feel differently about being offered tissues, but I don't think it can be assumed that the offer reflects some sort of pathological deficit on the part of the therapist. I think how a person receives the offer of tissues or lack thereof is about that person more than the offerer.