What happens during the free consultation?

The consultation is a short phone call to give you a chance to ask me anything you want to know about working with me: how I approach the work, what to expect from a session, whether I can meet your scheduling needs, how billing works, or anything else that would help you decide if this is the right fit. This isn't a clinical intake or a deep dive into what you're going through, just an overview so we both feel comfortable working together. If you want to move forward after that, we'll talk about next steps.

How do I schedule?

You can book your preferred appointment type here. If you'd prefer to reach out first, you can email me at mike@mikeorourke.co.

Do I need a referral?

No referral is needed. You can reach out directly. That said, if you're coming from a physician or psychiatrist, I'm open to coordinating with your care team when that's useful.

Where is your office, and what should I know before coming in?

I work out of two office locations in Polson, MT. Where we meet will be determined by the day of your appointment. If you have questions about parking or accessibility, feel free to reach out before your first session.

How does telehealth work?

Telehealth sessions are conducted via a secure, HIPAA-compliant video platform. You'll need a private space, a reliable internet connection, and a phone or computer with a camera. Sessions are never recorded. Telehealth is available to anyone located in Montana. Research consistently shows it's as effective as in-person therapy for most concerns.

How often would we meet?

Most people start with weekly sessions. Over time, we may shift to biweekly or less frequent sessions depending on where you are and what you're working on. We'll figure that out together.

How long does therapy typically last?

There's no single answer to this. It really depends on what you're working on, how long certain patterns have been in place, and what you want to get out of it. Some people work with me for a few months around a specific transition or challenge. Others stay longer because they find the ongoing work valuable. What I can say is that I don't aim to keep people in therapy longer than is useful. We'll check in on progress regularly and you'll always have a say in the pace and direction.

How much do sessions cost?

Psychotherapy is $160 per 55-minute session. Coaching starts with a $160 initial consultation, with ongoing fees determined collaboratively based on the scope and frequency of work.

Do you accept insurance?

Yes. I accept a number of insurance plans. Because coverage varies, the best way to confirm is to contact me directly at mike@mikeorourke.co or 406-360-1795 before scheduling.

What is the sliding scale, and do I qualify?

I hold a limited number of sliding scale spots for clients who need a reduced fee. If cost is a barrier, reach out directly and we'll figure something out. I'd rather have that conversation than have you not get in touch at all.

What does out-of-network mean, and how does reimbursement work?

If I'm not in-network with your insurance plan, you may still be able to get reimbursed for a portion of session fees through your out-of-network benefits. I work with Thrizer to make this process straightforward — rather than paying the full fee upfront and waiting for reimbursement, Thrizer lets you pay only your estimated co-insurance at the time of the session and handles the rest directly with your insurance. I can walk you through how it works when we connect.

What's the difference between psychotherapy and coaching?

Psychotherapy is a licensed clinical service. It's appropriate when you're dealing with depression, anxiety, trauma, grief, or patterns that feel stuck and are causing real difficulty. It's exploratory, sometimes slower, and looks at where things came from as much as where they're going.

Coaching is not clinical. It's forward-focused and works well for people who are functioning well but want to get clearer on their direction — their values, their work, what they actually want. It doesn't carry a diagnosis and isn't covered by insurance.

Both are collaborative and substantive. The difference is in the framework and what you're bringing to the table.

How do I know which one is right for me?

If you're experiencing significant emotional distress, mental health symptoms, or something that feels clinical in nature, therapy is likely the right fit. If you're more interested in intentional growth, clarity, or direction — and things are generally working — coaching may be a better match.

For couples and families, it's worth knowing that I offer coaching but not therapy in those contexts. If you're looking for couples or family therapy specifically, I can help point you toward someone who offers that.

Not sure? That's exactly what the free consultation is for.

Can I do both, or switch between them?

Therapy and coaching are kept separate, both ethically and practically. If your needs shift over time, we can talk about what makes sense. The important thing is that whichever we're doing, it's the right fit for where you are.

What approaches do you use?

I draw from several evidence-based frameworks depending on what fits the person and the work — including Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and psychodynamic approaches. I don't follow a single model rigidly. The research is pretty clear that the quality of the therapeutic relationship and the fit between approach and person matters more than any particular method. So we'll find what works for you.

Do you prescribe medication?

No. As a therapist, I don't prescribe medication. If medication is something you're interested in or your care warrants it, I can coordinate with a prescribing physician or psychiatrist.

What if I've had a bad experience with therapy before?

It's more common than you might think. A bad experience often comes down to fit — the relationship, the approach, or the timing — and that's worth naming. But therapy is also a bit like going to the gym: you get out what you put in. A good therapist can create the conditions for change, but the work happens on your end too. If you've been through therapy before and felt like it didn't do much, it's worth asking honestly whether the fit was off, whether the timing was right, or whether you were ready to really engage with it. Sometimes it's all three. If you decide to try again, I take the working relationship seriously, and I'd rather you tell me when something isn't landing than quietly disengage. We can always adjust.

Is everything I share confidential?

Yes, with a few specific legal exceptions. Confidentiality can be broken if there's a serious risk of harm to yourself or someone else, if there's suspected abuse of a child or vulnerable adult, or if records are subpoenaed by a court. Outside of those situations, what we discuss stays between us. I'll go over this in detail during our first session.

Are you accepting new clients?

Yes, I'm currently accepting new clients for both psychotherapy and coaching. The best way to get started is to book a free consultation.

Do you work with couples or families?

My therapy practice is focused on individual adults. I offer couples or family therapy only as additions to individual therapy with an identified patient. I am open to working with couples and families in a coaching context. If that's something you're interested in, reach out and we can talk through what that might look like.

Do you work with teenagers or minors?

Yes. I work with teenagers as well as adults. In Montana, individuals 16 and older can consent to their own therapy and book directly. For younger teens, a parent or guardian would need to be involved in the process. If you're a parent looking for support for your teen, feel free to reach out and we can talk about whether it's a good fit.