Fortunately, my therapist kept multiple boxes of kleenex in easy reach of you no matter where you were sitting in his office. Kind of cut out the whole issue of handing or not handing the tissue to you which was good as far as I was concerned.

ETA: I didn't cry in therapy for many years. It had nothing to do with not having been allowed to cry growing up or anything; I think it was more of an internal control thing for me. But eventually it just started happening. I found it rather mortifying at first, and I would NOT have wanted the therapist bringing attention to my crying by offering kleenex - I needed the control to do that on my own. Eventually, crying was like my normal in therapy. I didn't like it (too much tears and snot. LOL), but I wasn't embarrassed about it particularly anymore either.

My therapist knew me well enough to generally not react to my crying. The only times he did was if the crying seemed to be part of a flashback - that was a whole other can of worms. Normally, he just let me be because he knew that was what I needed.

We all have such different needs in therapy, and communicating what you need is necessary because otherwise, the therapist is honestly going to have to guess and will probably get it wrong initially because it's a bit of a crap shoot for them really. Does this client want me to say something? Does this client prefer to be left on their own to regain composure? Etc, etc, etc.