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2023 Edition

NCMHCE Practice Test

Take this free NCMHCE practice test to get an idea of the types of questions on the National Clinical Mental Health Counselor Exam. Once you pass the NCMHCE, you can become a National Certified Counselor (NCC), a credential offered by The National Board for Certified Counselors. The NCMHCE is composed of case studies with multiple-choice questions cover such areas as assessment, intervention and rehabilitation. When you are ready to prepare for the actual test, try our full-length 500 question Practice Exam for the NCMHCE.

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1.	Case Study 1 Initial Intake Age: 45 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Asian Relationship Status: Single Counseling Setting: Community outpatient clinic Type of Counseling: Individual Presenting Problem: Li is a self-referral. She walked into the clinic and stated that she had been experiencing feelings of anxiety. Mental Status: During the intake she looked visibly anxious. She appeared jumpy and kept looking at her watch. Although hesitated at times when she was asked a question. The counselor was concerned when Li paused for a long time when asked if she ever thought of hurting herself. Li eventually responded no. The counselor noticed that Li’s clothes looked disheveled and soiled. Li was not forthcoming with information about her past. History: Li came into the community outpatient clinic asking to pay a sliding scale fee in cash. When asked for identifying information, Li asked if she had to give that information. She explained that she was undocumented and was weary of leaving any information that may lead government officials to her. Li did not want to give the counselor much of her history and cut the intake session short, stating that she had to get back to work. An appropriate response from the counselor to Li’s situation would be:
		a. We must use your name for our records.
		b. Don't worry, if we use your real name, nothing will happen.
		c. We can use a pseudo name if that is what you are most comfortable with.
		d. How much can you pay?
There may be times when a client may not want to use their real name. If they are not paying through insurance, this should be accommodated. A client should not be forced to use their legal name. In this instance the client is concerned because they are not documented. It would be misleading to tell client to not worry and that nothing would happen to them. Asking about payment is not addressing the client’s question and is insensitive to what the client is expressing. Incorrect answer. Please choose another answer.

2.	Li is concerned about her ability to pay. Which of the following is NOT true in regard to counselor code of ethics?
		a. In establishing fees for professional counseling services, counselors consider the financial status of clients and locality.
		b. Counselors do not have to discuss payment during informed consent since it may change during treatment.
		c. If a counselor\'s usual fees create undue hardship for the client, the counselor may adjust fees or make an appropriate referral.
		d. Counselors make a reasonable effort to provide services to the public for which there is little or no financial return.
Counselors must discuss payment during the informed consent process, as well as payment modalities and inform clients that they may change at any time, if applicable. When establishing fees, there are many things for the counselor to consider such as location and financial status of clients. If the counselor realizes that payment is causing a hardship, appropriate steps must be taken such as referring out or lowering fees. Counselors also ensure that they give back in providing services pro bono to the community, trainings for future counselors, or reducing fees. Incorrect answer. Please choose another answer.

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3.	An important area to gain more information on at this point is:
		a. Cultural factors
		b. Source of anxiety
		c. Social support
		d. Financial situation
It is evident that Li is distressed enough to come to counseling even though she believes she is putting herself at risk and maybe cannot afford it. Starting with the source of her anxiety is important. This may lead to discussion about the other areas which would all be discussed during a comprehensive intake. However, the source of Li's anxiety should be addressed first. Incorrect answer. Please choose another answer.

4.	Counseling Session 1 During the first session, Li explained that she came to the United States four months ago after a wealthy US family invited her here to be their nanny. She was told that she would be able to get a stipend for clothes, decent pay, health benefits and even paid time off. However, Li shared that what was described is not currently the life she is living. Li described that for the past few months she has been basically sleeping in a closet with a bed in it, works tremendously long hours and is not allowed to eat the same things as the family. Additionally, the family frequently berates her and addresses her with racial slurs. How should the counselor respond to Li's description of her situation?
		a. "That sounds like a tough job."
		b. "This happens all the time."
		c. "How was it like in your homeland?"
		d. "You should not be treated this way."
Li is in an exploitive situation, and it must be addressed that this is not safe or appropriate. Choices a. and b. minimize what Li is experiencing and disregards her safety and well-being. Choice c. is assuming that Li had a worse experience where she came from and also minimizes what she is currently going through. Incorrect answer. Please choose another answer.

5.	Which of the following steps should the counselor take?
		a. Give Li a referral to a shelter.
		b. Tell her she needs to find another place to live.
		c. Suggest finding another job.
		d. Encourage Li to go to the police.
Li is a victim of human trafficking and exploitation, and the police should be involved. The counselor should encourage Li to go to the police. If she does not, the counselor must consider the level of risk there is. Ethical Code B.2.a. Serious and Foreseeable Harm and Legal Requirements states that "The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception." A referral to a shelter, would be beneficial after the authorities are contacted. Telling Li she needs to find another place to live would not be the appropriate choice. Although this must be done, simply stating that without calling the authorities or giving her resources would not be appropriate. Li will also have to find another job eventually but the priority is keeping her safe and reporting what happened to authorities. Incorrect answer. Please choose another answer.

6.	By saying, "Tell me about your experience coming into a new culture and going through what you did" The counselor is demonstrating the attribute of:
		a. Cultural awareness
		b. Curiosity
		c. Empathy
		d. Inclusion
Cultural awareness is understanding that someone's cultural experiences and views are unique and may differ from your own. Curiosity is being inquisitive about a different culture. Empathy is trying to put yourself in the shoes of another and inclusion is providing equal access or opportunities to others who may be marginalized. Incorrect answer. Please choose another answer.

7.	Counseling Session 2 After the initial session, Li was able to report her situation to the authorities and applied to live in a shelter for women. Li reported that since she has been at the shelter, things have been a bit better. Although she has not yet found employment, she feels a better sense of independence. Li did share that something upsetting that happened when she was on the subway. Li stated that she saw someone who looked like her previous employers, and she had an abrupt surge of fear. Li stated that she started sweating and shaking, her heart was pounding, and she felt like she couldn’t breathe. A passerby noticed that she was having difficulty and helped her to sit down and get a drink of water. Li's reaction on the subway meets the criteria for:
		a. Panic Disorder
		b. Panic Attack
		c. Hyperventilation
		d. Paroxysmal episode
What Li described meets the criteria for a panic attack. It does not yet meet the criteria for Panic Disorder which consists of repeated attacks. Hyperventilation is rapid or deep breathing often caused by panic. A Paroxysmal episode can mimic a seizure and may include loss of consciousness. Incorrect answer. Please choose another answer.

8.	Li should be referred to:
		a. A group for human trafficking survivors
		b. Employment counselor
		c. Care manager
		d. All of the above
All of the above would be helpful for Li. Being part of a group for human trafficking survivors can provide support for Li while helping her to see that she is not alone. An employment counselor can help her target a job congruent with her skills and interests. A care manager can help Li to coordinate her services. Incorrect answer. Please choose another answer.

9.	An effective treatment for anxiety is:
		a. Cardiovascular exercises
		b. Cognitive Behavioral Therapy
		c. Benzodiazepines
		d. Corticosteroids
Benzodiazepines have been shown effective for anxiety. Corticosteroids treat conditions such as asthma, allergies, arthritis and bronchitis. They have also been shown to make people anxious. Cardiovascular exercises are not proven to help prevent panic attack. Cognitive behavioral therapy can be used to target irrational thought which may trigger anxiety. Incorrect answer. Please choose another answer.

10.	A symptom of Panic Disorder is:
		a. Recurrent panic attacks
		b. Persistent worry about panic attacks and maladaptive change for 2 weeks
		c. Caused by separation from home or attachment figures
		d. Symptoms are only precipitated by social situations
Panic Disorder is characterized by recurrent panic attack with symptoms such as sweating, trembling, nausea, dizziness or derealization. Persistent worry about panic attacks and or maladaptive changes must be present for at least a month. If panic attacks are caused by separation from home or attachment figures, this would be separation anxiety disorder. Additionally, if symptoms are only precipitated by social situations, this is indicative of social anxiety disorder. Incorrect answer. Please choose another answer.

11.	Case Study 2 Initial Intake Age: 8 Gender: Male Sexual Orientation: N/A Ethnicity: Caucasian Relationship Status: N/A Counseling Setting: Through agency inside school and via telehealth Type of Counseling: Individual Presenting Problem: Attention and concentration deficits Diagnosis: Attention-deficit hyperactivity disorder, combined type (F90.2) Presenting Problem: Avery is an 8-year-old Caucasian male that has been referred to you by his school counselor because of emotional breakdowns, failing grades and falling asleep in class. You set up an initial assessment session with Avery and his parents in person at the school’s conference room and learn that he refers to his biological mother as “dad” and her wife as “mom”, and that he has a twin brother with Autism. Mom tells you Avery sees a psychiatrist for medications but frequently has them changed because she feels they are not working. Mom reports Avery has trouble sleeping at night, hits and kicks her and his brother when he’s angry and steals food from the kitchen and hides it in his room. She must ask him multiple times to complete a task and he often will not comply or forget each time he is told. Dad adds that Avery is very smart and does well in most subjects in school but struggles with reading comprehension and worded math problems. Avery is already on an IEP (Individualized Educational Plan) in school to better support his unique learning needs. They ask for your help in regulating his affect and behaviors. Mental Status Exam: Avery presents as fair, with some stains on his t-shirt. His mood is euthymic but with anxious affect as evidenced by hyperactivity, some pressured speech and fidgeting of the hands and feet as he cannot sit still. There is no evidence of suicidal or homicidal ideation and no reported hallucinations or delusions. The initial assessment revealed no significant trauma, other than not having his biological father around his entire life. Avery reports feeling tired often but overall happy. Mom reports his appetite is very good, but his diet could be better. He also has headaches at times in school or when he comes home. Family History: Avery is very close with his two mothers and does not seem to notice that he does not have his father present in his life. His mother mentions that he has made several remarks recently about wanting to be a girl. Avery’s brother is high functioning on the autism spectrum but has poor communication and coping skills, increasing Avery’s stress level at home due to their constant fighting. Both parents work full-time and take shifts in caring for the children, often sleeping at odd hours of the day and therefore have trouble keeping Avery on a regular schedule. Avery has some extended family on both sides and sees them occasionally. Dad reveals she was also diagnosed with ADHD and Dyslexia growing up and had trouble in school. Which of the following is not a behavioral definition of ADHD?
		a. Impulsivity as evidenced by frequent intrusions into other\'s personal business
		b. Susceptibility to distraction by extraneous stimuli and internal thoughts
		c. Frequent disruptive, aggressive, or negative attention-seeking behaviors
		d. Exhibiting a marked impairment or extreme variability in intellectual and cognitive functioning
This definition describes a facet of autism spectrum disorder; answers a) through c) all correctly fall underneath the symptoms of attention-deficit hyperactivity disorder. Incorrect answer. Please choose another answer.

12.	Which instrument is the most appropriate for further screening Avery’s diagnosed symptoms?
		a. Vineland Adaptive Behavior Scales (VABS)
		b. Screen for Childhood Anxiety Related Emotional Disorders (SCARED)
		c. Conners Parent and Teacher Rating Scale (CPTRS)
		d. Child Behavior Assessment Instrument (CBAI)
The CPTRS measures the presence and severity of behaviors related to ADHD exploring inattention, hyperactivity, learning problems and social skills, filled out by parents and teachers. It also helps point out where further testing may be needed or monitor how well medication is working for children already diagnosed with ADHD, as is the case with Avery. The VABS measures how a child’s daily living skills compare to those of other kids his age, helpful for screening diagnoses of autism spectrum disorder, Asperger’s syndrome, and developmental delays. This instrument would be more helpful for use with Avery’s brother in this case, but no evidence suggests Avery is having developmental issues. The SCARED is a child and parent self-report instrument used to screen childhood anxiety disorders ages 8-18 years old and could be used to identify anxiety issues, however the question asks about Avery’s already diagnosed conditions. The CBAI helps identify young children at risk of behavioral problems in community settings, which is not the most appropriate choice for this case study. Incorrect answer. Please choose another answer.

13.	Regarding Avery’s comments about desired gender, which of the following courses of action is the most clinically appropriate?
		a. Add diagnosis of gender dysphoria and include gender confusion as part of goals
		b. Do nothing because gender dysphoria for children his age is unsubstantiated
		c. Do nothing unless Avery or his parents bring it up again as part of a problem
		d. Refer parents to a support group for children coping with transgender issues
Avery was referred for counseling to address symptoms resulting from his primary diagnosis of ADHD and both of his parents are requesting help with dysregulation related to this issue only. Neither parent has expressed concern or problematic behavior resulting from gender identity confusion, merely it was mentioned as a remark that was made. While gender dysphoria can very well be a legitimate concern for a child his age, begin the treatment planning process focusing on presenting problems related to the diagnosis. Should Avery or his parents bring up gender confusion later in counseling, the issue can certainly be addressed and explored at that time. While the counselor may have a personal theory of its connection to Avery’s behavioral problems, it is best practice to first rule out known existing conditions. Referrals to support groups or other referrals, should only be made when the counselor deems it appropriate outside of clinical counseling, once the problem and need have been thoroughly assessed. Incorrect answer. Please choose another answer.

14.	Which of the following is a long-term goal as opposed to a short-term objective?
		a. Parents set firm, consistent limits and maintain appropriate parent-child boundaries
		b. Consult with school personnel to implement behavioral classroom management interventions
		c. Parents and the client demonstrate increased knowledge about ADHD and its treatment
		d. Complete psychological testing to measure the nature and extent of ADHD
Working with the parents on developing and maintaining consistent boundaries at home is an important factor in the effectiveness of your treatment of Avery and would be considered a longer-term goal as it will involve several objectives and interventions delivered over the length of your counseling relationship. Answer a) is a short-term objective that would be paramount in this treatment plan for Avery. Answer b) is an intervention underneath the banner of a short-term objective, and answer d) is also a short-term objective, however it is better conducted by a psychologist. Incorrect answer. Please choose another answer.

15.	First session, two weeks after the intake session You visit with Avery back in the school’s conference room during his math class. He tells you he does not like that class and is happy to be out of it, saying “I am too stupid. It’s too hard.” Throughout the session Avery abruptly interrupts you and races off to gather a different activity off the shelf or wants to switch topics of conversation. You call mom afterwards to touch base with how his moods and behaviors have been in the past two weeks. She reports that he is still stealing foods and hiding them, fighting with his brother, and having trouble sleeping. She asks what she should be doing at home to resolve the behaviors. What is the best response for how to guide this parent while building the therapeutic alliance?
		a. "Don't worry, you're doing a great job and he will grow out of this phase eventually."
		b. "You have to implement stronger boundaries in order for my interventions to be effective."
		c. "Use negative reinforcement to deter his behavior and CBT for addressing negative patterns."
		d. "I will educate you on the Behavioral Parent Management Training approach and we will explore the benefits of these techniques together."
Parent behavior management training is an evidence-based treatment teaching parents how to manage difficult childhood behaviors (defiance, outbursts, noncompliance). Validating and encouraging a parent like in answer a) is positive, a positive attitude to have however dismissing the behavior or the parent’s role in reinforcing the behavior is not clinically best practice when you are responsible for treating the child conducting those behaviors. Answer b) is an aggressive response to a parent who is actively seeking advice and support, however the need for stricter boundaries may be something the parent should consider. Negative reinforcement and CBT (cognitive behavioral therapy) techniques are also appropriate to teach the parent, but this response assumes the parent understands these terms. It is also best practice to collaborate with the parent on what interventions they have already tried already, and work towards empowering them to select their own options as this approach tends to be the most effective. Incorrect answer. Please choose another answer.

16.	First session, two weeks after the intake session You visit with Avery back in the school’s conference room during his math class. He tells you he does not like that class and is happy to be out of it, saying “I am too stupid. It’s too hard.” Throughout the session Avery abruptly interrupts you and races off to gather a different activity off the shelf or wants to switch topics of conversation. You call mom afterwards to touch base with how his moods and behaviors have been in the past two weeks. She reports that he is still stealing foods and hiding them, fighting with his brother, and having trouble sleeping. She asks what she should be doing at home to resolve the behaviors. Which of the following interventions support the objective to improve Avery’s ability to identify positive traits and talents about himself?
		a. Develop with Avery a list of positive affirmations about himself and assign him to read it daily
		b. Reinforce verbally Avery\'s use of confidence and positive affirmations about himself
		c. Present Avery with a piece of candy for each positive trait he can identify every session
		d. Watch a video with Avery about a character who defeats his struggle with schoolwork
Verbal reinforcement is the best way to help Avery remember how it feels to reflect positively on himself as it signals an immediate praise-based reward each time he uses a positive affirmation on his own. Making a list is a great way to remember his positive traits however assigning him to read on his own might only exacerbate his frustrations with reading and cause aversion towards the content since reading is what is making him feel bad. Use of prizes may cause immediate compliance and increased alertness with activities in session however is only reinforcing extrinsic or external motivation to do so and will not provide lasting change. Videos with engaging content are helpful tools to use occasionally, however this is not an optimal choice with this child’s low attention span and hyperactivity. Incorrect answer. Please choose another answer.

17.	First session, two weeks after the intake session You visit with Avery back in the school’s conference room during his math class. He tells you he does not like that class and is happy to be out of it, saying “I am too stupid. It’s too hard.” Throughout the session Avery abruptly interrupts you and races off to gather a different activity off the shelf or wants to switch topics of conversation. You call mom afterwards to touch base with how his moods and behaviors have been in the past two weeks. She reports that he is still stealing foods and hiding them, fighting with his brother, and having trouble sleeping. She asks what she should be doing at home to resolve the behaviors. Avery has a history of multiple medication switches with his psychiatrist. Which of the following steps would not be necessary to do for your treatment planning?
		a. Ask the parents to provide a copy of Avery\'s Psychiatric records
		b. Help the parents identify and explore patterns of behavior and root causes
		c. Inquire about which medications he was on and their effectiveness
		d. Provide education on stimulants and other prescriptive regimens
Answers b) through d) are all appropriate ways to better understand Avery’s journey with mental health medications and addressing each of these items can support the parents in their decision making going forward. While you can view the records of other providers with parental consent of your minor client (whether the parents provide them to you, or you submit a release of information and request them from the provider directly) it is not necessary for your treatment planning considerations. Incorrect answer. Please choose another answer.

18.	Second session, two weeks after the first session You decide to meet with Avery’s parents again together and in person along with Avery’s school counselor briefly before having your next session with Avery. The school counselor reports Avery’s emotional responses to difficulties in class have not been as severe as in past weeks, but that he is still falling asleep during morning classes. Dad mentions that Avery is often up late playing video games despite their attempts to get him to sleep. Mom adds they have settled on a medication regimen that has reduced Avery’s physical aggression, but that he is less communicative now and “spaces out” more. In meeting with Avery, he presents as more focused on your intervention attempts but when you ask how he has been feeling he reports “I don’t feel anything, really.” Which type of therapy encompasses teaching emotion regulation and distress tolerance that would be helpful for Avery in case of future behavioral outbursts?
		a. Cognitive Behavioral Therapy
		b. Dialectical Behavioral Therapy
		c. Applied Behavior Analysis
		d. Holistic Therapy
Emotion regulation and distress tolerance are taught facets from the school of Dialectical Behavioral Therapy (DBT) which would be helpful for Avery in learning how to manage his emotions, tolerate frustration and regulate his affect. This is especially a good choice for a client who has little insight into their problem (either from a maturity standpoint, age, cognitive ability, or to help with personality disorder) and needs help controlling their bodily reactions immediately without necessarily understanding the underlying reasons why they react the way they do. Cognitive behavioral therapy (CBT) approaches will also be useful for Avery but focus on identifying and changing negative beliefs and thought patterns that contribute to maladaptive behaviors, which is critical for long term change. Applied Behavior Analysis (ABA) is the preferred intervention for autism, and holistic therapies can be considered to provide additional support but are not all clinically evidence-based and do not directly apply to the interventions listed in the question. Incorrect answer. Please choose another answer.

19.	Second session, two weeks after the first session You decide to meet with Avery’s parents again together and in person along with Avery’s school counselor briefly before having your next session with Avery. The school counselor reports Avery’s emotional responses to difficulties in class have not been as severe as in past weeks, but that he is still falling asleep during morning classes. Dad mentions that Avery is often up late playing video games despite their attempts to get him to sleep. Mom adds they have settled on a medication regimen that has reduced Avery’s physical aggression, but that he is less communicative now and “spaces out” more. In meeting with Avery, he presents as more focused on your intervention attempts but when you ask how he has been feeling he reports “I don’t feel anything, really.” In response to Avery’s parents telling you how difficult it is to get him to sleep, you reply saying “I completely understand it must be difficult! I am here to help however I can.” This is an example of:
		a. Reverse reflection and deflection
		b. Non-judgmental stance
		c. Development of conflict resolution strategies
		d. Empathic responding using validation and therapeutic alliance
This is an example of showing empathy by validating a client’s feelings and reinforcing the therapeutic relationship by reminding them of your commitment to give your clinical resources to help alleviate their distress. Answer a) is a fabricated counseling skill. All clinical services should be provided from a non-judgmental position, offering unconditional positive regard as best practice. Developing resolution to their conflicts is at times a collaborative process along with the client, as well as it is a teaching process, that will continue throughout the course of their treatment. If the response were to include strategies, there would be instructions and SMART goals involved. This response was merely using core counseling attributes as a skill to enhance the client’s trust and comfort their apparent frustrations. Incorrect answer. Please choose another answer.

20.	Second session, two weeks after the first session You decide to meet with Avery’s parents again together and in person along with Avery’s school counselor briefly before having your next session with Avery. The school counselor reports Avery’s emotional responses to difficulties in class have not been as severe as in past weeks, but that he is still falling asleep during morning classes. Dad mentions that Avery is often up late playing video games despite their attempts to get him to sleep. Mom adds they have settled on a medication regimen that has reduced Avery’s physical aggression, but that he is less communicative now and “spaces out” more. In meeting with Avery, he presents as more focused on your intervention attempts but when you ask how he has been feeling he reports “I don’t feel anything, really.” As you are concluding your conversation with Avery’s parents, they ask if you can also treat his twin brother Marc, who has autism spectrum disorder and is non-verbal. You should reply:
		a. "I am happy to conduct an assessment, but I also might refer you to an ABA Specialist."
		b. "I can't treat him or help you with that, but Google some local autism resources."
		c. "It is unethical to provide counseling for a family member of an existing client."
		d. "Of course I can treat him! Let me check my calendar and we will get him right in!"
It is best practice to offer or assess each client on your own prior to agreeing to or denying services. To better understand Marc’s needs, conducting an assessment can help you to rule out which conditions you can or cannot support. You should also prepare your clients to know that external support from other specialists might be an option you provide depending on the client’s needs that may be outside of your scope of practice. It is not unethical to treat more than one member of the same family depending on the circumstances and situation, specifically when it comes to child siblings; often the parents of children in counseling will prefer the same counselor to meet with their different children and resolve family dynamics issues and provide insight to the parent. The situation must be screened for boundary issues and unethical dual relationships or roles. Answer d) sounds supportive and encouraging but could be giving a family false hope if agreeing to provide services without properly screening through initial assessments. Incorrect answer. Please choose another answer.

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Quality starts with who wrote the material.

Our practice exam writer

Jenny Preffer-Davis, LMHC, ACS, NCC, RN

is a professor in the Graduate Counseling Department at Grace College. She has been a LMHC for over fifteen years and is an owner of a mental health clinic and career coaching service in Jacksonville, Florida.

Joanne Fortune, PhD, LMHC

is an adjunct professor in counseling at Mercy College in New York where she assists students in preparation for board certification. She is also Regional Director of SCO Family Services in New York City.

Tara Williams, LPC, MCAP

is a community therapist in Georgia in a number of elementary and middle schools. She has also worked as a primary therapist and clinical compliance coordinator in outpatient treatment centers in substance abuse and family therapy.

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