The National Clinical Mental Health Counseling Exam is taken by those who are seeking licensure and certification as a Mental Health Counselor in their state. This exam is maintained by the National Board for Certified Counselors or NBCC, which is nationally recognized for producing exams that lead the field in counselor credentialing. Those who pass this have proven they have the skills, knowledge, and abilities necessary to succeed as professional mental health counselors.
Online NCMHCE Prep Course
If you want to be fully prepared, Mometrix offers an online NCMHCE Prep Course. The course is designed to provide you with any and every resource you might want while studying. The NCMHCE Course includes:
- Review Lessons Covering Every Topic
- 750+ NCMHCE Practice Questions
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The NCMHCE Prep Course is designed to help any learner get everything they need to prepare for their NCMHCE exam. Click below to check it out!
Who is Eligible?
All NCMHCE testing candidates are required to register with the Center for Credentialing and Education or CCE before you schedule an exam. The CCE is an affiliate of NBCC used to oversee this examination process.
You will also need to check with your state board in regards to any specific information about licensure or credentialing procedure. Your state may require you to apply with them before you take the NCMHCE. Your state may also allow exam-exemption if you have previously taken and passed an NBCC exam.
There is a fee of $ to sit for the NCMHCE. This must be paid during your registration process either online or by direct mail. These fees are not refundable or transferable and they expire within one year if the registration process has not been completed or an exam scheduled.
When and Where Can I Take It?
After your application and registration have been approved, you will receive an email notification that you are able to schedule your exam. This will include your candidate ID number and instructions on how to use it to schedule for the NCMHCE.
The exam is administered by computer year-round, typically the first two full weeks of every month, except on holidays. Tests can be scheduled Monday through Saturday with most exams beginning at 8 am and the last one starting at 5:30 pm. There are no registration deadlines and your registration can be completed, filed, and paid for at any time.
All administrations of the NCMHCE are held by Pearson VUE at over 250 testing sited located throughout the U.S. Space is filled on a first-come-first-served basis. So, it is recommended to book your exam as early as possible and about 60 days before your desired exam to ensure your preferred time, date, and location.
Special accommodations are available for those with disabilities who may not be able to test under normal conditions. These requests must be made by contacting Pearson VUE. Your request and its supporting documentation will be reviewed and if found acceptable it will be approved. You should not schedule your exam until you have received approval confirmation.
Should you need to change your exam appointment for any reason you may do so at any time prior to the last seven days before your scheduled exam. If you make any changes to your exam within those seven days, you will be charged a $50 rescheduling fee. Changes cannot be made in the last 24 hours before your exam appointment.
What Should I Bring?
Pearson Vue recommends that you arrive at the testing center for your exam appointment early. There is a sign-in/check-in process that will need to be completed before you can test. If you arrive more than 15 minutes late, you will not be allowed to test that day and will have to re-register for the NCMHCE, as well as pay another registration fee for another date.
The above-mentioned check-in process will require that you bring forms of personal identification with you. One of these must contain a recent and recognizable photo. Both forms must include your full legal name as it appears on your application/registration information and your signature. Please be sure to make sure these are not expired and are valid.
Acceptable forms of primary or photo identification are:
- Driver’s license
- State ID card
- Military ID card
- Passport
As this exam is given using a computer, you will not need to bring any personal items with you. This includes electronic devices such as cell phones and calculators, food and drinks, and pencils and study material. These items are strictly prohibited and must be kept in a designated locker during the exam.
What Does it Cover?
Unlike most exams, this one is not designed to test your memory of isolated facts and figures. The NCMHCE is designed to evaluate your problem-solving capabilities in a clinical environment. For that reason, this exam consists of 10 clinical mental health counseling cases. Within these cases are five to ten Information Gathering (IG) or Decision Making (DM) classified sections.
One of these cases or simulations will be used for pre-test purposed only and will not be calculated in your score. This case will not be identified, making the completion of all 10 cases imperative.
Below are a brief outline and examples of the areas and topics that this exam will cover.
Assessment and Diagnosis
- Identify precipitating problems or symptoms
- Identify relevant family issues
- Integrate client assessment and observational data
- Identify individual and/or relationship functioning
Counseling and Psychotherapy
- Clarify counselor/client roles
- Implement individual counseling in relation to a plan of treatment
- Inform the client about ethical standards and practice
- Evaluate referral information
Administration, Consultation, and Supervision
- Assist clients with obtaining services
- Maintain case notes, records, and/or files
- Conduct professional communications
- Determine if services meet clients’ needs
The Information Gathering or IG sections will ask you to gather diagnosis and treatment information for your client.
The Decision Making or DM sections will expect you to make a clinical decision or judgment based on the scenario.
Both sections are formatted similarly to multiple-choice questions. Some questions may ask you to choose the single best option while others may have more than one answer to be chosen. It is important to read through each question entirely to make sure you understand if only one answer or several can be chosen.
How is it Scored?
You will be given a paper copy of your unofficial score report by the examination proctor after you have finished at the testing center. This will include your personal information, pass/fail status, and a brief report of your performance on the Information Gathering and Decision Making sections.
After your scores and testing behavior have been verified, the CCE will send official passing scores to your licensing organization or state board. This usually happens within 30 days of the end of your testing cycle. It is important to note that passing of the exam alone does not qualify you for licensure.
As each exam, its questions, and its number of scored simulations differ slightly, each exam version may have a slightly different passing score. These are predetermined by the NBCC.
If you do not pass the exam, you may retake it once every three months. You will need to re-register and pay the appropriate fee to do so.
How Can I Prepare for the NCMHCE Test?
We believe that different learning styles require different tools for success. We have compiled a list of the best study guides, flashcards, and practice tests that we’ve found on the market. Some of these guides have review videos, for you visual learners out there. Others have practice tests, which have been proven to increase student scores by a whole letter grade (in some cases more than that)!
Best Online Course:
Top Study Guides:
High-Quality Flashcards:
NCMHCE Practice Test
Simulation
Mark, a 25-year-old Caucasian male, calls for an appointment without disclosing any specific concerns. He works for a barber and beauty supply business, and drives a local delivery route in and around the city in which he resides. He has been married for two years, and he and his wife have one newborn child.NOW GO TO SECTION A.
Section A: Initial Information Gathering.
The client seems reluctant to reveal his reason for seeking counseling. What might you do and say to put him more at ease?
DIRECTIONS: Select as many as you consider correct.
- 1. Can you tell me what’s on your mind?
- 2. Do you have any concerns about seeing a counselor?
- 3. Shall we discuss my fee schedule?
- 4. Who referred you to see me?
- 5. Most people seeing a counselor just need some feedback about their lives. What brings you in today?
- 6. Do you understand that homework may be required?
NOW GO TO SECTION B.
Section B: Identify the most positive client-therapist spatial arrangement in an office during an initial intake session:
DIRECTIONS: Select the arrangement likely to be helpful to the client at intake.
- 1. The counselor and client seated at an angle from each other with nothing between them.
- 2. The counselor and client seated across a desk from each other.
- 3. The counselor seated directly in front of a diploma and certification plaques to reassure the client.
- 4. The counselor standing and pacing while talking to the client.
- 5. The client recumbent on a couch while talking with the counselor.
NOW GO TO SECTION C.
Section C: Diagnostic Formulation.
Identify the most likely diagnosis, given the available information.
DIRECTIONS: Select the single most likely diagnosis in this situation.
- 1. Generalized Anxiety Disorder (300.02)
- 2. Adjustment Disorder with Mixed Disturbance of Emotions and Conduct (309.4).
- 3. Substance-Induced Anxiety Disorder (292.89).
- 4. Acute Stress Disorder (308.3).
- 5. Generalized Anxiety Disorder (300.02).
- 6. Obsessive-Compulsive Disorder (300.3).
NOW GO TO SECTION D.
Section D: Optimum Treatment Modality.
From among the following, indicate the best treatment approach.
DIRECTIONS: Select the TWO most appropriate options provided in this Section.
- 1. Engage the client in insight-oriented psychotherapy.
- 2. Provide cognitive-behavioral therapy.
- 3. Refer the client for electro-convulsive therapy.
- 4. Refer the client for a medications evaluation.
- 5. Begin a regimen of behavioral therapy.
NOW GO TO SECTION E.
Section E: During the client’s medication evaluation, you discover that the psychiatrist you normally refer to is unavailable, and another clinician is temporarily cross-covering her referrals. Upon returning, your client informs you that the cross-cover psychiatrist has enrolled him in a medications study to investigate the effectiveness of a new medication. He has been randomized into a group that could receive either a placebo or the investigational medication. Describe an appropriate first response to this information.
DIRECTIONS: Select the one most appropriate first response in this situation.
- 1. Rely on the investigational physician to resolve any subsequent concerns about Mark’s treatment via the research study.
- 2. Ask Mark if he understands the purpose of the study.
- 3. Tell Mark that he needs to drop out of the study if he intends to continue working with you.
- 4. Consult with the physician (via information release) about Mark’s safety concerns in driving.
NCMHCE Practice Test Answers and Explanations
Section A: Element Relevance and Initial Information Obtained.
- Can you tell me what’s on your mind?
INDICATED (+2)
This question is open and non-threatening, and it allows the client to easily express his concerns in any way that suits him. - Do you have any concerns about seeing a counselor?
NOT INDICATED (-1)
While this is a forthright question, it presumes the client is worried about seeing the counselor, and may prompt a defensive (or overly reassuring) response. - Shall we discuss my fee schedule?
NOT INDICATED (-2)
This question could be seen as downright disrespectful and suggests that the client is either miserly or else unable to afford the counseling services. - Who referred you to see me?
NOT INDICATED (-2)
This question could be perceived as an attempt by the counselor to pursue marketing and referral concerns, instead of voicing genuine concern about the client and his reasons for being there. - Most people seeing a counselor just need some feedback about their lives. What brings you in today?
INDICATED: (+2)
This question “normalizes” the clinical engagement process, and then allows the client to frame a response in his own way. - Do you understand that homework may be required?
NOT INDICATED (-2)
This question suggests that the client is either lazy or resistant, or both. Therefore, it is not an appropriate intake question.
Section B: The value and relevance of potential information to share.
1. The counselor and client seated at an angle from each other with nothing between them.
MOST USEFUL (+3)
This spatial arrangement suggests equality, and an open engagement process.
2. The counselor and client seated across a desk from each other.
LESS USEFUL (+1)
This spatial arrangement suggests a professional barrier exists between the counselor and client.
3. The counselor seated directly in front of a diploma and certification plaques to reassure the client.
LESS USEFUL (-1)
This suggests either an attempt at professional dominance, or an effort to cover professional insecurity. Neither will benefit the encounter. While the presence of credentials can be appropriate, the placement should be non-threatening.
4. The counselor standing and pacing while talking to the client.
NOT USEFUL (-2)
Pacing in the presence of a client would be distracting, agitating, and suggest a marked lack of interest and investment in the client.
5. The client recumbent on a couch while talking with the counselor.
NOT USEFUL (-1)
This posture would not be effective for an intake session, unless a client personally requested it or was not feeling well.
RESPONSE DEVELOPMENT:
Using an appropriate pattern of questioning and an optimal spatial arrangement, the client now reveals his concerns. He has been driving a delivery truck for nearly one year. He now knows the route very well and is comfortable with his assignments. However, in recent months he has begun to experience problems. He has had a recurrent fantasy or “daydream” of what it would be like to “go back in time” with modern accoutrements (his vehicle, clothing, knowledge, and the like). While the fantasy was just “good fun” in the beginning, it has begun to “take over” his thinking. Recently, it has become so intrusive and preoccupying that he has begun missing deliveries and is less than fully safe on the road. He is seeking help in coping with this situation. As he speaks, it is clear that he is embarrassed about what is happening, and yet overwhelmed by it enough to seek help. He is fearful of losing his job, or perhaps even getting in an accident and injuring others and himself.
Section C: Relevance of Diagnosis Options.
1. Adjustment Generalized Anxiety Disorder (300.02).
NOT INDICATED (-1)
The client’s issue is very specific, and beyond this diagnostic category.
2. Adjustment Disorder with Mixed Disturbance of Emotions and Conduct (309.4).
NOT INDICATED (-1)
If any other Axis I disorder better fits the symptoms, then this diagnosis must not be applied. In this situation, there is a better fit.
3. Substance-Induced Anxiety Disorder (292.89).
NOT INDICATED (-2)
There is no indication of substance abuse.
4. Acute Stress Disorder (308.3).
NOT INDICATED (-1)
There is no precipitating “traumatic event,” which is the core feature of this diagnosis.
5. Generalized Anxiety Disorder (300.02).
NOT INDICATED (-1)
For this diagnosis to apply, the focus of the client’s “anxiety and distress” must not be “confined to features of [another] Axis I disorder. In this case, there is another Axis I disorder that is the source of the client’s distress.
6. Obsessive-Compulsive Disorder (300.3).
INDICATED (+3)
This client’s issues properly fit the “obsessive” features of this disorder. His obsession involves: 1) “recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress; 2) the thoughts, impulses, or images are not simply excessive worries about real-life problems; 3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action; [and] 4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion).”
Section D: Options Review and Findings:
1.Engage the client in insight-oriented psychotherapy.
NOT INDICATED (-3)
Insight-oriented psychotherapy has a poor track record in modifying OCD symptoms over the long term, although it may offer some short-term emotional benefits and support.
2. Provide cognitive-behavioral therapy.
INDICATED (+2)
Because the client’s issue is primarily a thought-based obsession (as opposed to a behaviorally-based compulsion), this therapeutic approach is optimal. Using a cognitive restructuring approach, the client can be assisted in identifying the various triggers and disruptive thoughts associated with his obsession, and can learn to replace them with more realistic, functional thoughts. Given that the issues is being caught relatively early (involving only months, rather than years), the restructuring process should be relatively swift and very successful.
3. Refer the client for electro-convulsive therapy.
NOT INDICATED (-1)
This approach is sometimes used in cases of Obsessive-Compulsive Disorder, but it is not typically a first-choice approach. Other techniques and approaches are normally attempted first.
4. Refer the client for a medications evaluation.
INDICATED (+2)
The use of anti-depressant medication can be a particularly effective adjunct in the treatment of Obsessive-Compulsive Disorder. Therefore, a referral for a medications evaluation would be most appropriate. If prescribed, a monitoring and feedback component would be an important part of any treatment plan.
5. Begin a regimen of behavioral therapy.
NOT INDICATED (-2)
Behavioral therapy alone is more appropriate for situations where persistent compulsions are evident. However, where behavioral compulsions are absent, as in this scenario, the process of cognitive restructuring is a necessary addition to any behavioral treatment components used.
Section E: Disposition Relevance and Rationale Formulation.
1. Rely on the investigational physician to resolve any subsequent concerns about Mark’s treatment via the research study.
NOT INDICATED (-2)
It is not appropriate for a counselor to abdicate responsibility for a client’s health and well-being simply because the client has been enrolled in a study. The NBCC Code of Ethics Section E, #3, reminds counselors that although the “ultimate responsibility for ethical research lies with the principal researcher,” it is essential that “others involved in the research activities” be “ethically… responsible for their own actions.”
2. Ask Mark if he understands the purpose of the study.
NOT INDICATED (-1)
While some discussion of the client’s understanding of the study may be in order, it is not the most pressing issue for further address. As emphasized in the NBCC Code of Ethics Section B, #8, requires that a counselor take “reasonable steps to ensure that clients understand the implications” of any intervention being used.
3. Tell Mark that he needs to drop out of the study if he intends to continue working with you.
NOT INDICATED (-1)
NBCC Code of Ethics Section A, #1 stipulates that a counselor should
“engage in continuous efforts to improve professional practices, services, and research.” Undermining a research study without clear cause would not necessarily advance either the patient’s best interests or the profession. This action could also undermine NBCC Code of Ethics Section B, #2, which states that counselors should “strive to establish positive and collaborative professional relationships that are in the best interest of the client.”
4. Consult with the physician (via information release) about Mark’s safety concerns in driving.
INDICATED (+3)
By enrolling the client in the investigational study, the possibility exists that the client will be randomized into a placebo (no medical treatment) group. This could result in the client receiving less than adequate available treatment. Given that the client has explicitly stated he fears for his driving safety when engaged in his obsessive thoughts, this concern must be addressed further. Specifically, the NBCC Code of Ethics Section B, #4, stipulates a counselor “must take reasonable action” if there is “a clear and imminent danger to the client or others.” The NBCC Code of Ethics Section B, #2, emphasizes the need for a formal information release for consultation between colleagues to take place.
SCORING: (Max = maximum possible; MPL = minimum passing level)
3A. Max 4; MPL 2
3B. Max 4; MPL 2
3C. Max 3; MPL 2
3D. Max 4; MPL 2
3E. Max 3; MPL 2
