NCMHCE (NATIONAL CLINICAL MENTAL
HEALTH COUNSELING EXAMINATION)
PRACTICE QUESTIONS& ANSWERS WITH
DETAILED RATIONALES
---
## Questions 1–50: Professional Practice and Ethics
1. A client discloses during the third session that they have been having
thoughts of harming a coworker. The client does not have a specific plan but
states, "They deserve to pay for what they did to me." What is the counselor's
MOST appropriate initial action?
A. Maintain confidentiality as no specific plan has been articulated
B. Immediately contact the coworker to warn them of the potential threat
C. Assess for imminent danger and review the limits of confidentiality with the
client
D. Terminate the session and report the client to law enforcement
Correct Answer: C
Rationale: The counselor must assess the immediacy and severity of the
threat. Reviewing limits of confidentiality is essential when a client discloses
potential harm to others, as it reminds the client of the counselor's duty to
protect. Immediate contact with the coworker (B) would be premature
without proper assessment. Maintaining confidentiality (A) is inappropriate
given the duty to protect. Terminating the session (D) is an overreaction that
abandons the client.
,---
2. A counselor has been providing therapy to a client for two years. The client
unexpectedly inherits a large sum of money and offers to pay the counselor an
additional $5,000 as a "thank you" gift. The counselor should:
A. Accept the gift as it is offered freely by the client
B. Accept the gift only if it is less than $100 in value
C. Decline the gift and discuss the therapeutic implications of the offer
D. Accept the gift but document it in the client's file
Correct Answer: C
Rationale: Accepting significant monetary gifts from clients creates a dual
relationship that can compromise objectivity and exploit the therapeutic
relationship. The counselor should decline and process the meaning of the
offer with the client. While nominal gifts may be acceptable in some
circumstances, a $5,000 gift is clearly inappropriate.
---
3. A 16-year-old client is brought to counseling by their parents. The parents
demand to know everything discussed in sessions. The client states they do
not want their parents to know what they share. The counselor should:
A. Share all information with the parents as they are paying for treatment
B. Refuse to see the client unless the parents agree to stay out of treatment
C. Explain the limits of confidentiality to both the client and parents, including
minor consent laws in the state
,D. Tell the client that everything will be kept confidential regardless of what
the parents want
Correct Answer: C
Rationale: Minors' confidentiality rights vary by state. The counselor must
explain these limits to both the client and parents, including what information
may need to be shared and under what circumstances. The counselor cannot
make blanket promises of confidentiality (D) nor can they ignore the parents'
legal rights (A). Refusing to see the client (B) does not address the ethical
obligation.
---
4. A counselor is treating a client who is also being seen by a psychiatrist for
medication management. The psychiatrist calls and asks for a summary of the
client's therapy sessions. The counselor should:
A. Provide a verbal summary over the phone
B. Provide a written summary only if the client signs a release of information
C. Refuse to share any information as it would violate confidentiality
D. Share information only if the psychiatrist agrees to reciprocal sharing
Correct Answer: B
Rationale: A release of information signed by the client is required before
sharing any protected health information with other providers, even when
coordination of care is beneficial. Verbal sharing (A) without documentation is
insufficient. Refusing all sharing (C) may impede treatment coordination, but
proper consent is required.
---
, 5. A counselor discovers that a colleague is engaging in a sexual relationship
with a current client. The counselor has witnessed the colleague and client
together outside of sessions on multiple occasions. The counselor's FIRST
ethical obligation is to:
A. Confront the colleague directly about the relationship
B. Report the colleague to the licensing board immediately
C. Consult with the colleague to encourage termination of the relationship and
seek supervision
D. Discuss the situation with the client to verify the relationship
Correct Answer: C
Rationale: The counselor should first consult with the colleague to address the
unethical behavior directly and encourage corrective action. If the colleague
refuses to terminate the relationship and seek supervision, the counselor
would then have a duty to report to the licensing board. Confrontation (A)
without consultation may be premature. Reporting immediately (B) should
occur only after attempts at resolution fail.
---
6. A counselor is terminating services with a client who has achieved
treatment goals. The client becomes tearful and states, "I don't think I can
make it without you." The counselor's BEST response is to:
A. Extend treatment for another three months
B. Reassure the client that they have the skills to succeed independently
C. Explore the client's feelings about termination and reinforce their progress
D. Refer the client to another counselor for continued support
HEALTH COUNSELING EXAMINATION)
PRACTICE QUESTIONS& ANSWERS WITH
DETAILED RATIONALES
---
## Questions 1–50: Professional Practice and Ethics
1. A client discloses during the third session that they have been having
thoughts of harming a coworker. The client does not have a specific plan but
states, "They deserve to pay for what they did to me." What is the counselor's
MOST appropriate initial action?
A. Maintain confidentiality as no specific plan has been articulated
B. Immediately contact the coworker to warn them of the potential threat
C. Assess for imminent danger and review the limits of confidentiality with the
client
D. Terminate the session and report the client to law enforcement
Correct Answer: C
Rationale: The counselor must assess the immediacy and severity of the
threat. Reviewing limits of confidentiality is essential when a client discloses
potential harm to others, as it reminds the client of the counselor's duty to
protect. Immediate contact with the coworker (B) would be premature
without proper assessment. Maintaining confidentiality (A) is inappropriate
given the duty to protect. Terminating the session (D) is an overreaction that
abandons the client.
,---
2. A counselor has been providing therapy to a client for two years. The client
unexpectedly inherits a large sum of money and offers to pay the counselor an
additional $5,000 as a "thank you" gift. The counselor should:
A. Accept the gift as it is offered freely by the client
B. Accept the gift only if it is less than $100 in value
C. Decline the gift and discuss the therapeutic implications of the offer
D. Accept the gift but document it in the client's file
Correct Answer: C
Rationale: Accepting significant monetary gifts from clients creates a dual
relationship that can compromise objectivity and exploit the therapeutic
relationship. The counselor should decline and process the meaning of the
offer with the client. While nominal gifts may be acceptable in some
circumstances, a $5,000 gift is clearly inappropriate.
---
3. A 16-year-old client is brought to counseling by their parents. The parents
demand to know everything discussed in sessions. The client states they do
not want their parents to know what they share. The counselor should:
A. Share all information with the parents as they are paying for treatment
B. Refuse to see the client unless the parents agree to stay out of treatment
C. Explain the limits of confidentiality to both the client and parents, including
minor consent laws in the state
,D. Tell the client that everything will be kept confidential regardless of what
the parents want
Correct Answer: C
Rationale: Minors' confidentiality rights vary by state. The counselor must
explain these limits to both the client and parents, including what information
may need to be shared and under what circumstances. The counselor cannot
make blanket promises of confidentiality (D) nor can they ignore the parents'
legal rights (A). Refusing to see the client (B) does not address the ethical
obligation.
---
4. A counselor is treating a client who is also being seen by a psychiatrist for
medication management. The psychiatrist calls and asks for a summary of the
client's therapy sessions. The counselor should:
A. Provide a verbal summary over the phone
B. Provide a written summary only if the client signs a release of information
C. Refuse to share any information as it would violate confidentiality
D. Share information only if the psychiatrist agrees to reciprocal sharing
Correct Answer: B
Rationale: A release of information signed by the client is required before
sharing any protected health information with other providers, even when
coordination of care is beneficial. Verbal sharing (A) without documentation is
insufficient. Refusing all sharing (C) may impede treatment coordination, but
proper consent is required.
---
, 5. A counselor discovers that a colleague is engaging in a sexual relationship
with a current client. The counselor has witnessed the colleague and client
together outside of sessions on multiple occasions. The counselor's FIRST
ethical obligation is to:
A. Confront the colleague directly about the relationship
B. Report the colleague to the licensing board immediately
C. Consult with the colleague to encourage termination of the relationship and
seek supervision
D. Discuss the situation with the client to verify the relationship
Correct Answer: C
Rationale: The counselor should first consult with the colleague to address the
unethical behavior directly and encourage corrective action. If the colleague
refuses to terminate the relationship and seek supervision, the counselor
would then have a duty to report to the licensing board. Confrontation (A)
without consultation may be premature. Reporting immediately (B) should
occur only after attempts at resolution fail.
---
6. A counselor is terminating services with a client who has achieved
treatment goals. The client becomes tearful and states, "I don't think I can
make it without you." The counselor's BEST response is to:
A. Extend treatment for another three months
B. Reassure the client that they have the skills to succeed independently
C. Explore the client's feelings about termination and reinforce their progress
D. Refer the client to another counselor for continued support
