Question: Here is a question I've been troubled by for a while. Many times, people will send their kid or spouse to therapy, but the kid or spouse is somewhat in denial or confused. They may see reality in a twisted way or be somewhat lying to themself or only see their side of the picture due to their emotional/mental health issue. When they sit and talk to the therapist, they are only giving over that twisted picture of reality and the therapist will then guide them according to what they hear, which is sometimes a ridiculous view of reality and if the therapist asked anyone else in this person's life, they would get a drastically different picture as they all see how messed up this person is. Often, (as I've experienced with a sibling and heard other accounts) they get awful advice that only makes the problem much worse, through no fault of the therapist, since this is what he heard and is falling for, hook, line, and sinker! Have therapists thought of this obvious and common issue, and is there a way around it?  

Can I protect my adult-sibling from getting the ridiculous advice by me or my parents having a short talk to clue the therapist in on reality, or does that break confidentiality? 

These situations are rare but they do sadly exist. This highlights the importance of seeking out an experienced therapist with good recommendations, especially for complex cases. 

I have seen how therapists have drawn conclusions about a spouse or parents based on their clients report without meeting the other party (or reaching out to their therapist). A therapist should not agree to a diagnosis (e.g., refer to a spouse as having a personality disorder), call something abuse, and certainly not recommend significant changes (e.g., divorce) without a comprehensive evaluation of the other party and situation.  This is a violation of professional ethics as well as a violation of the spirit of shamoia bein achiechem. Incidentally, this is sometimes done by Rabbonim and Askonim too. We can never judge the other side without doing a comprehensive evaluation and ascertaining the facts. 

The vast majority of therapists, however, do not work this way.  Those working more from a systems or CBT perspective will certainly welcome and seek input from all parties to obtain the full picture. One can ask the client for consent to speak with others. Alternatively, a therapist can listen to significant others without disclosing anything that the client has shared. 

Other therapists, especially those who work from a relational or psychodynamic orientation, may choose not to speak with third parties, but their way of working is ethical and grounded

They view what the client chooses to communicate as more important that what others report about them. This is not necessarily because it is true, but because it is relevant. The client needs a safe place to explore what they personally experience--even if they experience it as abuse or trauma--and not to be told (or thought) that it is not so based on someone else's criteria. Being viewed as incorrect would compromise their safety, trust, and ability to heal at one's own pace.  Of course, the therapist understands that this is the client's reality, which has its objective limitations.  Hence, while they seek to understand their clients worldview,  they would not advise the client to make any life decisions that affect others based on their limited understanding and will certainly not advocate for the client in the real world because they understand that their perspective is important for the client but not necessarily objective.