Is ChatGPT Actually Therapy? What a Clinical Therapist Says AI Gets Wrong

MELISSA Over 230 million people ask ChatGPT questions every single week. And a growing number of those people are actually using ChatGPT as their therapist. So today I am sitting down with Paula Lain Smykle, a licensed clinical therapist of Paula Lain Counseling here in Sioux Falls. She's watching this play out real time in her practice, not anti-AI, because she says she uses it herself, but she has a very specific answer to the question everyone should be asking. And that is what does AI actually do when you pour all of your mental health into it and what does it leave out? We're also going to be talking about something that does not exist anywhere else here in the region. And that is dog-assisted counseling. We have Ollie here today who comes to some of those sessions. It is backed by research and it's changing how people experience therapies. Health and wellness is confusing. There's a new trend every week. Everyone's got an opinion and half the time you can't tell what's legit and what's just good marketing. And we get it. We're in it too. Welcome to Dialed In Health. I'm Melissa Goodwin. Every episode we bring in the people who actually do this work, providers, practitioners, the experts who seek clients and patients every day. We ask the questions you'd ask if you were sitting across from them so you can find the right people, make better decisions and feel confident about what's out there, whether it's peptides, gut health, water quality, ADHD, biohacking, or something you've never heard of, we're covering it. So let's get into it. Let's get dialed in.

MELISSA Paula, I'm so glad you're here today. Welcome to the show.

PAULA Thank you for having me and for having Ollie.

MELISSA Yeah. He's chilling out here right now. So after we got through the intro, he decided to take a little sit down. So I'm curious, you describe your practice as goal-based, no BS therapy. So tell us a little bit about what that means.

PAULA I would say that our strategy and approach to offering counseling in the community is very real. So we like to help anyone and everyone, right? Reach their goals, go through and get through the other side of whatever the problem is or transition, whether it's interpersonal relationships, friendships, family, romantic relationships, whatever that is, but in a really comfortable and real way. I guess I would say a good example of no BS is we don't necessarily sit back and say, "And how do you feel about that? And let's be mindful," you know, kind of all of those...

MELISSA Feels like platitudes sometimes or just like, it doesn't mean anything.

PAULA Cliche words, phrases that we see around the space of therapy. We challenge, and it's a really positive conversation. I always say when I work with my patients and our other therapists at the practice here, they can trust us. And it's just like having a natural conversation with a person that you've known for a really long time.

MELISSA Well, I'm curious, how does someone know that they need therapy? Because many times we're like, "I can just figure this out. I just need to figure this out." Right? What are some of the signs or things you would experience if you might need some therapy?

PAULA Most people — I'll kind of work backwards from this. Most people land in a therapy or counseling office. Those words are interchangeable. They're not different. It's all the same thing. When their life is — they feel like they're crashing and burning. And the problem has become so big that they then think, okay, I need to seek help, I need to figure this out. I recommend therapy 10 steps before that. When you know that there's something that's not really going right in your life and you're not really sure how to process it or what direction, come to us. If it is impacting your everyday life, even in a small way, come to us. And then we walk with you in figuring out what that is. We don't give advice. I would say I don't give any advice because if it doesn't work, then I'm on the line here. We just walk beside you and we're objective. And so we can say, all right, here's what I'm seeing. And here's what you're telling me in a really, really supportive way and say, what has not worked for you? How about trying this perspective? And then we support through the entire way. And if that doesn't work, okay, let's pivot. Let's do this. Your therapist helps you get through that. And then we're sort of like your lifeline for maintenance. After that you can come back. Life is not just one problem, right? Life just happens. Life is really messy and our thoughts are really messy. And so you have your person to just help you navigate that.

MELISSA When do I go to like a good friend and just spill the tea and when do I hire a therapist?

PAULA When your friend says, "This is a lot." Okay.

MELISSA When you realize that. My friends always say that. So now I'm nervous.

PAULA I think it's when you're with friends and you're realizing that it's not reciprocal. So you're saying, "Hey, this is what's going on in my life." And I'm venting, venting, venting. And almost every time that you're with your friend or with your family member, you're talking about that same stressor or different stressors. And it's not a conversation. And you might hear your friends say, "Wow, this is a lot," or not really say much, or "I don't know what to do with this." And eventually friends or family will say, "You know, you might want to talk to somebody else, a professional about this." Those are kind of key words where you would then go into the therapy space rather than...

MELISSA Cues that you might need to find a professional that can help guide you. Right. So obviously we get a lot of information on TikTok and Instagram. And I'm sure you've seen a lot of people diagnose themselves from social media, or we see a lot of words like gaslighting or weaponizing and things that you see all over. So what's the risk of diagnosing yourself based on what you see on TikTok or Instagram?

PAULA It's very, very, very dangerous. Your average counselor, therapist, clinical social worker that works in the therapy space has had 10 years of training to understand how to treat symptoms and to diagnose mental health disorders. I really don't even like the term mental illness because I think it just creates a barrier for people who are seeking help for everyday life things that are impacting them. But what TikTok and social media and Instagram is doing is — not making the issues common — they are expanding, in my experience, labeling. And so if you have, in 10 seconds, right — I mean, the span of these videos is just rapid, quick, scroll, scroll, scroll, scroll. So they have to get your attention. "Are you a person who feels very stressed and tired at the end of the day?" Well, yes. Everybody does. "Are you a person that has mood swings?" Well, yeah, sometimes. Everybody does. But then when they put a label on it, it makes it really dangerous because then you have people walking around thinking, "Okay, well, there's something wrong with me," but I don't know anything past that. A diagnosis isn't what a person is. It is what a person is experiencing. And it is literally in our diagnosing Bible, the DSM. It's just a category of symptoms that lets us know how we can treat that.

MELISSA Right. So labeling without having an expert guide you isn't really helpful. It's just saying, you know, this is that and this is this, and it may not even be accurate.

PAULA Right. I think it's dangerous because it most oftentimes is not accurate.

MELISSA Sure. We're all selfish a little bit, but we're not all narcissists. But that's a word that everybody is really clinging to.

PAULA Right. Yes. And so when social media uses clinical terms like that, it loses relevance. It erases the actual clinical definition of what those are. And so if you're not working with a professional that can help define what some of those things are, you just don't know. And then you start kind of over-generalizing. And to go back to, I guess, the danger — it's really nice to know, like when I go to the doctor and there's something and they say, "Hey, we know what that something is," and you're like, "Oh, okay, that feels good." I think that that's why people are holding on to it. But then past that, they're not saying seek professional help, see if this is accurate for you or not. I think everyone wants to know more about themselves, but most of the time it's just inaccurate, and it's information that's given by people that are making money off of your views and not professionals.

MELISSA Yeah. And we all have some little angst thing, and of course social media is playing into your fear or your frustration. And so if you have a little clip that says, "I bet you're with a narcissist, try this," or, "These are all the traits," then of course we all get drawn into that. So tell me, what is it that a therapist does that AI — well, we haven't really talked about AI. We've got a lot of people using AI as their therapist these days. Ollie's like bored with this conversation. He's like, "I'm out of here. I don't want to talk about AI. I want to talk about snacks." We should have brought some snacks to keep him interested. So there's a danger, obviously, in using AI as your therapist. Right? So there's obviously the danger of labeling with TikTok. What is the danger of using ChatGPT or Claude as your therapist?

PAULA I would say it's a computer. It's based on — I don't have any snacks, sorry — summarizing and scanning all of the internet. If the average person would put in, "How do I know I have anxiety?" — that can be really nice because it'll scan the internet and say, "Hey, here's some symptoms, here's some signs." You're like, "Oh, okay." If it said after that, "seek professional help," that would be great. That's how I use ChatGPT. And I recommend for all of my patients to use it as a helpful tool. It is not a person and it cannot replace the therapeutic relationship. And that's why therapy works. Most of the time when your therapist is not telling you something that you don't already know, but we're helping you get there. Get some clarity. And support you. And you feel a connection, and that's really like the magic of therapy. And what I've found is that AI is trying to imitate that. And so it will use really personalized language and you might say, "I'm experiencing this, this, and this," and they'll say, "Oh my gosh, you know, that seems terrible."

MELISSA Even in business settings, right? It'll say, "Oh, this is a great idea. Do you want me to develop a business plan around that?" Or if I'm looking at an email and I'm like, "Gosh, I don't know if I — does this have the right tone?" you know, so I'll have AI — "Hey, am I being too naive about this, or am I being too defensive about this?" And I'll put that into ChatGPT or Claude and get a response. And sometimes it's helpful, but it just tells me what I want to hear. "Oh, you know, you're not being too defensive." It feels like it's always telling me that I'm right.

PAULA Yes. Yes. Okay. So — thank you — getting me back on point. So when you'll say, "I'm experiencing these things," they'll say yes, and that is right. And so you get sort of lost in this echo chamber of more validation. Everybody loves to be validated. That they're right. But it just continues and it can actually grow that. And they'll say, "If you're thinking this, you might be thinking this too." And you'll say, "Oh my gosh, yeah." And then they'll offer different things. "Would you like to check out or explore this topic or this topic?" And then you really just go down that very, very narrow tunnel with no objective, no perspective of the context of your real life. Your computer does not know that. And so it'll say, "Yes, yes, yes, all of these things are wrong. You're okay. You are not wrong to think this or behave like this." And so it's always going to affirm it. I think can just really lead — anyone who has anxiety, anxieties, fear, and worry, trying to predict the future — just blowing that up, blowing it up. And I see it in my office all the time.

MELISSA Well, I'm sure it can take you down a rabbit hole or little trails that are maybe not useful because it's just saying, "Yes, yes, yes," without having the full context or having a professional to actually guide you into a place that might be uncomfortable but important for you to explore, I would imagine. Yeah. They're never going to challenge you. Right? Which we don't like to be challenged. We like to be affirmed. So that's why we like these little toys in our phone.

PAULA Right. Yes. Yes. Yeah. Right. Don't get me wrong — in my sessions and our sessions at PLC, we're not just fighting with our clients. We support them, but we do challenge. Like therapy should be hard. That means it's working. But we also laugh. We also have really deep relationships. So we're not just arguing and pushing all the time. Promise.

MELISSA No, I believe that. So give me an example. Obviously you can't share a specific, but like somebody that comes in and says, "Hi, I saw this on social media. I think it's this," you know, how might you explore that with them and help guide them onto the right track?

PAULA Right. So I'll start digging in and asking questions about why they're focused on that and other examples in their life of where they see that play out. Most of the time they'll just give me real life examples and I'm like, "Oh, okay, well, is that impacting you in a negative way?" And then they'll say, "Well, I guess not really." I'm like, "Oh, okay." And so asking more questions about how they're behaving at work or with their family or with their friends, then starts giving me more clues of kind of the distress or stress that they're really dealing with. And sometimes it is the same. Or similar. But it's really exploring the other systems of the person's world and how it's impacted. Because it's okay to have a personality and it's okay to feel not happy all the time and to feel mad and sad. And I think that another thing that internet and social media...

MELISSA Quick break. This episode is brought to you by Vitality Growth Labs. If you're a health or wellness practice and you're wondering why your phone isn't ringing in the way it should be, Vitality Growth Labs builds the systems to fix that — get found, build trust, fill your calendar. AI authority stacking, videos that connect with your clients, real tool strategy and execution that results in real revenue. Visit vitalitygrowthlabs.com or check the provider directory at vitalitygrowthlabs.com/the-directory to find a trusted wellness provider near you. All right, back to the show.

PAULA What really does not portray is the gamut of emotions. Like it is okay to be human and we are supposed to feel all of the things, not just happiness.

MELISSA So what do you feel, you know, as you think about different generations and how they're interacting with AI? Do you see differences in millennials or Gen Xers or boomers and how they're interacting from a mental health perspective? Do you see a difference?

PAULA I do. It's — I think it's really positive. So I feel like I've kind of been smashing on social media and AI and things like that. The culture is really improving in the comfort of people talking about mental health and talking about their brain health and talking about wellness, which is awesome. So the barriers for younger people that are growing up and always have had the internet, they're just decreasing. They feel more comfortable in saying, "Hey, I don't feel right. Hey mom, I need to see a therapist." That's really amazing. Then you get to the millennials. And so I would identify as a millennial. We don't know — we try to — what I see in my office and I personally have felt, like we try to push through those issues a lot longer before we see a professional. And then, sort of like our parents, then they like to just ignore that there's an issue or there's feelings attached to it at all until it's really unmanageable. But we are seeing that generation come accept help a lot sooner. I think traditionally, I think what most people would think — the younger, the easier, the more accepting they are of mental health, and kind of the older that you get and as you age, I think culture just told them that, you know, especially for women, like this is just life.

MELISSA I'm a Gen Xer, so I was a latchkey kid for a while, and you know, sort of like figure it out. And so you sort of joke that the Gen X generation — like we will be around the time of the apocalypse because we'll take care of everything. May or may not be true. May or may not be true. But we might not be very mentally healthy.

PAULA Okay. Well, I think that's a really good point though. Is that like, yeah, like you should have a certain amount of grit, right? Figure it out, try different things. And if that's not working, know that it's okay then to go to that next step.

MELISSA Yeah. So CBT — there's a lot of terms in mental health that are so confusing for people, like CBT. I don't even know all the alphabet soup. But just in common words, explain what these things are and how do I even know what to ask for? If I were to reach out to you, Paula, and say, "I think I might need help," I have no idea what I need.

PAULA You don't have to know anything when you reach out to a therapist. Okay. So all of those terms — CBT, so that stands for cognitive behavioral therapy; EMDR, which is eye movement desensitization, trauma therapy — you don't need to know those things. The therapists, when they get to know you and your presenting problem and what you need help with, we then shift and use whatever theory. Those are just modalities of treatment and theories. So we choose how we're going to direct therapy, but you won't even necessarily know or need to know. In one session, I'm probably using six different styles of therapy. So cognitive behavioral therapy would be one where we're really focused on core beliefs, thoughts, behaviors, and outcomes. And so you can do that in a really like free flowing conversation and therapy without even knowing it. EMDR is a little bit more technical. IFS, which is internal family therapy, is more meditative and you get to know the parts. There's the parts of yourself and how they protect you and how to navigate that. And there's just a million more. And so it's not anything very specific that the client needs to know at all, but the therapist will just guide you to figure out the right fit.

MELISSA Okay. If that makes sense. How do you know when to bring Ollie in?

PAULA So Ollie, he is always in session with me now, and he — treating me right now. Well, he is really paying attention to you. He really is. It's interesting. So Ollie is — he's paying attention to you. He's very calm. This is a little bit different of a space. He's usually in my office, you know, he just hangs out. He's really calm. And then he'll present himself to my clients when he's needed. And then I will ask the clients about their comfort level. He really breaks down barriers when going through trauma, self-esteem issues — there's a ton of different ways that we can use Ollie in session. But he really is intuitive. Okay.

MELISSA Yeah. So dog-assisted therapy, that is a thing. It is. Okay. So how did you get into this and what does this mean?

PAULA Yeah. So that's a really good question because there's so many different kinds of terminology, and I think it just gets kind of wrapped into one. So animal-assisted therapy, dog-assisted therapy specifically, is very similar to equine or horse therapy. Okay. So I'm always very clear with my clients that Ollie is not a traditional therapy dog. He works in my space and he works with me. So I can't borrow him out. I don't bring him to different spaces. He is used in a therapeutic setting. And then I incorporate him when appropriate with my clients' care. So I kind of got into it because I've always loved animals and dogs. The comfort that they give me, I think, is just so special and it's so powerful. And so I started researching in grad school and it literally doesn't exist in the United States. So you'll have therapists — probably everybody's like, "Yeah, that's not true. I see therapy dogs all the time." There are therapists that have dogs with them or in the space. And I can't speak for their therapy or how they use that — it is different. And there's no actual modalities that are carved out and saying, "Here's exactly how you would use that," in the United States. They follow, I think, a model in Israel actually, which they've done a ton of science and research on the impacts and studies of the positive outcomes of using animals in therapy. So we know that it works. We really, I think, need to develop it a lot more.

MELISSA So Ollie doesn't have any credential. He hasn't studied recently, but he is very helpful. Yes. Okay. Because you know how to use his intuition.

PAULA So yes, I have...

MELISSA He doesn't have any papers, although he does have a really good Coyotes collar. I appreciate that.

PAULA Yes. Yeah. Coyotes, got it. Yeah. He's representing USD. Yeah. He hasn't been to much school. Mama has.

MELISSA Yes. Yes. So you know how to use and leverage his intuition, and what you see when he interacts with your patients — you kind of know how to interpret all of that. Yes, exactly. Okay. So when he is in session with the client, what might you see that gives you clues or says, "I might need to dig into this more"?

PAULA It's really interesting. I'll give you two examples of the most powerful way that I've seen him. He usually hangs out behind the chair. You forget that he's even there. He won't lick, he won't jump. He doesn't cuddle. You can ask him to come, but he really has his own autonomy in that space. And then I use him as a tool. So when he shows up with clients — you think he would show up when they're emoting, right? So they're really anxious, really nervous. Maybe they're crying or something like that. That is not when Ollie shows up, because people are typically expressing what they need to. So their cortisol levels, although they are really high, and he can smell the hormone levels and things like that, he knows he's not needed. I can bring him over and incorporate him in that way. The times that I think have been the most powerful is when I've worked with — both of these were women — a woman who came in and I had worked with her weekly for probably six months. And it was just very — she had a hard time being vulnerable, a hard time expressing her emotions, so it was pretty topical, and that's okay. I work with what I have. And I knew that she needed to process a really substantial death in her family. And there was a session where Ollie had just come up, and this woman was very stoic. He just stood like this, and she said, "Oh, like Ollie, do you — do you want to pet Ollie?" And she said, "Oh yeah," she loves, loves, loves dogs. And then I've never seen it.

MELISSA He's like, "Thank you for sharing this story."

PAULA Yeah. He's doing a little bit of this, but he sat on the couch with her and was just really stoic. And then she shared with me, and really broke down, that the family member always had wanted a big black lab. Oh. And I said, "Oh, wow. That's so interesting." And then she started sharing the story of the loss, and Ollie was just there. And it was as if this person was speaking through Ollie, and he just presented himself. And then as she felt more comfortable talking, he let her pet him a little bit and then just kind of went back to his spot. And so it's like he allowed her that time and space and experience, but he just showed up like that. And then the other time there was a woman who'd been through a horrific ending of her marriage that — she left feeling belittled, emotionally abused. Her self-esteem took an absolute hit. And she is an incredible woman, works in the professional field, and is just at the top of her field. So the way that she would show up at work was very different than the way she actually felt personally about herself. And so we were doing some of the strength-based work with her, and she really could not tell me one good thing about herself. Oh, that's sad. It was. And this woman is incredible, right? She's doing so much in the community. She's a boss. She's at the top level. But in that space, she could do that. And then in therapy, she couldn't. Yeah, exactly. Ollie came over and really got up on the couch again, and the way that he presented — it was so interesting. He just was this powerful kind of statuesque dog right next to her. And then her body language changed as I was talking to her, and she started petting him, and it was like he gave her a sense of that confidence. And then she started going and saying, "Oh yeah, and then I do this, and I show up in this way, and I am really great at that." It was absolutely amazing. It was like he was just gifting her — just giving her a little bit of confidence.

MELISSA Yeah. That's amazing. You said something really interesting, that he can smell cortisol — hormone levels, the stress hormone. Dogs can smell that?

PAULA Yes. And so, yeah, we just have like a tip of knowledge about this, but there's been studies where a dog can — and this is not every dog can work in this capacity.

MELISSA Yeah. So my dog is definitely not one of these.

PAULA They can smell different hormones. Cortisol is our stress hormone. And we have — I don't know if a lot of people know this too — the composition of our tears is different as well, related to the emotions of why we're crying. And so they can actually smell that as well. So whether we're crying because we're physically hurt, we are emotionally crying because it's joyful, or crying because of sadness or grief — all of the compositions of that is different. And we actually sweat differently as well. So we sweat hormones out. And so all of that plays into what a dog can sense and smell. That's crazy. How they show up. And so some dogs, in the study that I was watching, they had elicited whatever emotional response for these people, so that they were stressed or whatever, and then they wrung out the sweat or tears or whatever, and then put these people in this room to see how a dog would respond. And some dogs would run away when they were close to that person who had the stress sweat or whatever, and would go into the corner, but other dogs would come closer. So it really all just depends, but they definitely have an extraordinary sense.

MELISSA To wrap this up a little bit, I'm curious who might be a good person that would benefit from the dog therapy.

PAULA Yeah, for dog therapy, I would say any client who really feels that they would have a hard time opening up. Animals just provide this sense of comfort and they break down that barrier. Anyone who's going through, or currently going through, or wanting to discuss past traumatic events, trust, anything like that. I would say kind of everyday transitions and things like that — Ollie's not really that. He doesn't need to be a tool in that way. But I would say definitely the people that are a little bit more closed. Younger — I'd say younger people really, really enjoy interacting, because it brings the focus off of them onto Ollie, and then they start talking and opening up. So, okay.

MELISSA Yeah. So as you think about anybody out there who might be interested in connecting, they may not have to say, "I need dog therapy." You would know if this would be a person who's going to benefit, just like you'd mentioned all the different modalities — you'll be able to guide whomever into what modality, and they don't need to know that, right? They don't need to understand. They just show up. What might be the first step if someone says, "Hey, Paula, I think I might want to reach out" — like where can people find you? Don't go to — maybe they can go to ChatGPT. Now they can go to ChatGPT and find you.

PAULA Yes. Yes. There we go.

MELISSA Well, how do people find you? Where are you located? How do they connect?

PAULA Yeah. So the way that we have people connect with us is all electronic. So just go to our website, which is paulalaincounseling.com, and anywhere on the page, you can connect and it will bring you to a new inquiry form. And so what that is, is just your name, date of birth. We ask if you have insurance, or if you're interested in a reduced private pay rate, and then a little narrative of "what are you needing help with?" So all of those inquiries come to me, and then I assess what is needed based on what they've shared. So then I connect that person with their best match at this office. So we have four other amazing therapists, all with different specialties. Also, I would say that most all therapists — you don't have to specialize in depression or specialize in anxiety. We all do that. I think that's another thing, but outside of that, we have other interests and topics. So I match them. And then what we do is we check and verify insurance and cost, and we make sure that you know exactly what it is going to cost you, if anything. We do all the insurance background, we get your agreement, and then we do everything through text. So the therapist then uses their business line to text you and schedule, and it's super streamlined. Nice.

MELISSA Perfect. So in parting today, if you were to put up a billboard for all the people using ChatGPT to tell them what their problems are, or using TikTok to tell them how to deal with their narcissist ex, what would you like to tell them?

PAULA I would say use ChatGPT as a tool to define what those things are. And if you're even thinking about anything about your brain health, your emotions, come and seek help to just run it by a therapist. Start there if you want information. But if it is really related to emotion, know that you also — if you're thinking that and you're putting it in ChatGPT, that is kind of your number one clue that we would like you — it would benefit you to talk with a therapist.

MELISSA Perfect. And I can tell Ollie agrees. He's just — he's like, "All right, I think I need a snack now."

PAULA Yeah, he's ready. He's — I mean, he's a good listener. He's just always just chilling.

MELISSA Oh, that's perfect. All right. So if you're interested in connecting with Paula, we'll put the link to Paula Lain Counseling in the show notes. You can also — are you on social media as well? Yes. Okay. Instagram and Facebook. You can also connect with her on Instagram and Facebook. Paula, thank you so much for being on the show today. If you're using ChatGPT as your therapist, make sure to check with Paula first.

PAULA Please, please, please, please. Or any therapist.

MELISSA Thanks for being on the show. Yeah. Thanks, Melissa. Hey, that's our show. If someone came to mind while you were listening to this, if you thought, "Hey, my sister needs to hear this," or "I should send this to my mom," or "my buddy would get a lot out of this," please share it with them. Just hit the share button and send it their way. You never know what one conversation, one episode, or one piece of information can do for someone who's been looking for answers. And if you haven't subscribed yet, please do it now. It takes two seconds. It's free. And it means you won't miss an episode. We've got incredible stuff coming up and I don't want you to miss any of it. And if you're a health or wellness provider and you want to be on the show, we'd love to hear from you. There's a link in the show notes to get in touch. We're always looking for people doing interesting work. We want to share what they know. And one last thing — I get asked all the time about the products and brands I actually use, so I've put together a list of sponsors and favorite products that have worked for me and my family. If you're curious, that link is in the show notes too. Thank you for being here. And I really mean that. See you next time.