Introduction to the NCMHCE (National
Clinical Mental Health Counseling
Examination)
1. Overview of the Exam Structure
The NCMHCE is a comprehensive examination designed to assess the knowledge and skills of
clinical mental health counselors. It is used by many state licensing boards as part of the licensure
process.
Key points about the exam structure:
The exam is computer-based and administered at testing centers.
It consists of 10 clinical mental health counseling cases.
Each case includes 5 to 10 decision points where the examinee must make choices about
assessment, diagnosis, or treatment.
The total exam time is 255 minutes (4 hours and 15 minutes).
There are no breaks scheduled during the exam, but candidates may take breaks as needed,
which count against the total exam time.
2. Types of Questions
The NCMHCE uses a case study format, which is different from traditional multiple-choice exams.
The question types include:
1. Information Gathering (IG): These questions assess the candidate's ability to identify and
explore clinically relevant information. Examinees select which pieces of information they
would gather to understand the client's situation better.
2. Decision Making (DM): These questions evaluate the candidate's ability to make appropriate
clinical decisions based on the information provided. Examinees choose the best course of
action from the options presented.
Both IG and DM questions are presented in a multiple-choice format, but unlike traditional exams,
candidates may select multiple correct answers for each question.
3. Scoring System
The NCMHCE uses a complex scoring system that takes into account both the quantity and quality
of responses:
Each question has a predetermined minimum and maximum score.
Candidates earn points for selecting correct options and lose points for selecting incorrect
options.
The total score is calculated based on the cumulative points earned across all cases.
There is no penalty for leaving a question blank, but selecting an incorrect answer will result
in lost points.
Key points about scoring:
, The exam is scored on a scale of 100-200.
A score of 100 is the lowest possible score, and 200 is a perfect score.
The passing score is determined by subject matter experts and may vary slightly from one
exam form to another.
As of 2024, the passing score is typically around 105-110, but this can change.
It's important to note that:
There is no fixed number of correct answers required to pass.
The difficulty of questions may vary, and this is taken into account in the scoring.
The exact scoring algorithm is proprietary and not publicly disclosed.
Candidates receive their unofficial scores immediately upon completing the exam. Official scores
are typically available within 4-6 weeks.
Preparation Tips
1. Focus on case conceptualization and clinical decision-making skills.
2. Practice working through complex clinical scenarios.
3. Familiarize yourself with the DSM-5 diagnostic criteria and treatment guidelines.
4. Develop a strategy for managing time effectively during the exam.
5. Use official NBCC study materials and practice exams to familiarize yourself with the exam
format.
Remember, the NCMHCE is designed to assess your ability to apply clinical knowledge in realistic
scenarios, not just to recall facts. Prepare accordingly by focusing on practical application of
counseling principles.
NCMHCE Practice Questions - Set 1
Case Study: Sarah
Sarah, a 28-year-old marketing executive, has scheduled an appointment with you. She reports
experiencing increasing anxiety and difficulty concentrating at work over the past six months.
Sarah mentions that she often feels overwhelmed and has trouble sleeping. She has been
avoiding social gatherings and has strained relationships with her coworkers. Sarah admits to
occasionally having a few glasses of wine in the evening to "take the edge off."
Questions:
1. Based on the initial information provided, which of the following would be the most
appropriate first step in assessing Sarah's condition?
a) Administer the Beck Anxiety Inventory
b) Conduct a thorough clinical interview
c) Refer Sarah to a psychiatrist for medication evaluation
d) Suggest Sarah join a support group for anxiety
2. During the clinical interview, Sarah reveals that she experienced a panic attack during a
presentation at work last month. Which of the following questions would be most relevant to
ask next?
a) "Have you experienced similar episodes in other situations?"
, b) "Do you think your coworkers noticed your panic attack?"
c) "Have you considered changing jobs to reduce your stress?"
d) "Are you taking any medications for anxiety?"
3. Sarah discloses that she has been drinking more frequently in recent months. Which
assessment tool would be most appropriate to evaluate her alcohol use?
a) CAGE questionnaire
b) Michigan Alcohol Screening Test (MAST)
c) Alcohol Use Disorders Identification Test (AUDIT)
d) Blood Alcohol Concentration (BAC) test
4. Based on the information gathered, which of the following diagnoses would you consider as
a possible primary diagnosis for Sarah?
a) Major Depressive Disorder
b) Generalized Anxiety Disorder
c) Alcohol Use Disorder
d) Social Anxiety Disorder
5. When developing a treatment plan for Sarah, which of the following interventions would
likely be most beneficial as an initial approach?
a) Psychodynamic therapy to explore childhood trauma
b) Cognitive-Behavioral Therapy (CBT) for anxiety management
c) Family therapy to address relationship issues
d) Exposure therapy for public speaking anxiety
6. Sarah expresses concern about her alcohol consumption. Which of the following responses
would be most appropriate?
a) Suggest she attend Alcoholics Anonymous meetings
b) Provide psychoeducation on the effects of alcohol on anxiety
c) Recommend she stop drinking immediately
d) Refer her to an inpatient detox program
7. During a session, Sarah reveals that she has been having thoughts of "not wanting to wake
up." What is the most appropriate immediate response?
a) Explore the nature and frequency of these thoughts
b) Contact her emergency contact listed in her file
c) Suggest an immediate psychiatric hospitalization
d) Prescribe an antidepressant medication
8. Which of the following goals would be most appropriate to include in Sarah's initial treatment
plan?
a) Achieve complete abstinence from alcohol within one month
b) Return to pre-anxiety levels of work performance within two weeks
c) Develop and practice coping strategies for managing anxiety symptoms
d) Confront and resolve conflicts with all coworkers within one month
9. Sarah mentions that her company offers an Employee Assistance Program (EAP). How might
you incorporate this information into her treatment?
a) Suggest she use the EAP instead of continuing therapy with you
b) Explore how the EAP might complement her current treatment
c) Advise against using the EAP to maintain confidentiality
d) Require her to enroll in the EAP as a condition of treatment
, 10. After several sessions, Sarah reports improvement in her anxiety symptoms but continues to
have difficulty with public speaking at work. Which of the following interventions would be
most appropriate to address this specific concern?
a) Refer Sarah to a career counselor to explore job options with less public speaking
b) Implement gradual exposure exercises for public speaking situations
c) Suggest Sarah disclose her anxiety disorder to her employer
d) Increase the frequency of therapy sessions to three times per week
NCMHCE Practice Questions - Set 1 with
Explanations
Explanations:
1. Correct answer: b) Conduct a thorough clinical interview
Explanation: A clinical interview is the most appropriate first step as it allows the counselor to
gather comprehensive information about Sarah's symptoms, history, and current life
situation. This provides a foundation for further assessment and treatment planning.
2. Correct answer: a) "Have you experienced similar episodes in other situations?"
Explanation: This question helps determine if Sarah's panic attacks are limited to work
presentations or if they occur in other contexts, which is crucial for accurate diagnosis and
treatment planning.
3. Correct answer: c) Alcohol Use Disorders Identification Test (AUDIT)
Explanation: The AUDIT is a comprehensive screening tool that assesses alcohol
consumption, drinking behaviors, and alcohol-related problems. It's particularly useful for
identifying harmful drinking patterns before they become severe.
4. Correct answer: b) Generalized Anxiety Disorder
Explanation: Sarah's symptoms of persistent anxiety, difficulty concentrating, sleep problems,
and social avoidance align closely with the diagnostic criteria for Generalized Anxiety
Disorder.
5. Correct answer: b) Cognitive-Behavioral Therapy (CBT) for anxiety management
Explanation: CBT is an evidence-based treatment for anxiety disorders. It can help Sarah
identify and change negative thought patterns and develop coping strategies for managing
anxiety symptoms.
6. Correct answer: b) Provide psychoeducation on the effects of alcohol on anxiety
Explanation: Educating Sarah about how alcohol can exacerbate anxiety symptoms is an
appropriate first step. It allows her to make informed decisions about her alcohol use without
imposing a specific course of action.
7. Correct answer: a) Explore the nature and frequency of these thoughts
Explanation: It's crucial to assess the severity and nature of Sarah's thoughts before taking
any drastic actions. This exploration will help determine the level of risk and appropriate
interventions.
8. Correct answer: c) Develop and practice coping strategies for managing anxiety symptoms
Explanation: This goal is realistic, measurable, and directly addresses Sarah's primary
concern. It provides a foundation for managing her anxiety in various situations.
Clinical Mental Health Counseling
Examination)
1. Overview of the Exam Structure
The NCMHCE is a comprehensive examination designed to assess the knowledge and skills of
clinical mental health counselors. It is used by many state licensing boards as part of the licensure
process.
Key points about the exam structure:
The exam is computer-based and administered at testing centers.
It consists of 10 clinical mental health counseling cases.
Each case includes 5 to 10 decision points where the examinee must make choices about
assessment, diagnosis, or treatment.
The total exam time is 255 minutes (4 hours and 15 minutes).
There are no breaks scheduled during the exam, but candidates may take breaks as needed,
which count against the total exam time.
2. Types of Questions
The NCMHCE uses a case study format, which is different from traditional multiple-choice exams.
The question types include:
1. Information Gathering (IG): These questions assess the candidate's ability to identify and
explore clinically relevant information. Examinees select which pieces of information they
would gather to understand the client's situation better.
2. Decision Making (DM): These questions evaluate the candidate's ability to make appropriate
clinical decisions based on the information provided. Examinees choose the best course of
action from the options presented.
Both IG and DM questions are presented in a multiple-choice format, but unlike traditional exams,
candidates may select multiple correct answers for each question.
3. Scoring System
The NCMHCE uses a complex scoring system that takes into account both the quantity and quality
of responses:
Each question has a predetermined minimum and maximum score.
Candidates earn points for selecting correct options and lose points for selecting incorrect
options.
The total score is calculated based on the cumulative points earned across all cases.
There is no penalty for leaving a question blank, but selecting an incorrect answer will result
in lost points.
Key points about scoring:
, The exam is scored on a scale of 100-200.
A score of 100 is the lowest possible score, and 200 is a perfect score.
The passing score is determined by subject matter experts and may vary slightly from one
exam form to another.
As of 2024, the passing score is typically around 105-110, but this can change.
It's important to note that:
There is no fixed number of correct answers required to pass.
The difficulty of questions may vary, and this is taken into account in the scoring.
The exact scoring algorithm is proprietary and not publicly disclosed.
Candidates receive their unofficial scores immediately upon completing the exam. Official scores
are typically available within 4-6 weeks.
Preparation Tips
1. Focus on case conceptualization and clinical decision-making skills.
2. Practice working through complex clinical scenarios.
3. Familiarize yourself with the DSM-5 diagnostic criteria and treatment guidelines.
4. Develop a strategy for managing time effectively during the exam.
5. Use official NBCC study materials and practice exams to familiarize yourself with the exam
format.
Remember, the NCMHCE is designed to assess your ability to apply clinical knowledge in realistic
scenarios, not just to recall facts. Prepare accordingly by focusing on practical application of
counseling principles.
NCMHCE Practice Questions - Set 1
Case Study: Sarah
Sarah, a 28-year-old marketing executive, has scheduled an appointment with you. She reports
experiencing increasing anxiety and difficulty concentrating at work over the past six months.
Sarah mentions that she often feels overwhelmed and has trouble sleeping. She has been
avoiding social gatherings and has strained relationships with her coworkers. Sarah admits to
occasionally having a few glasses of wine in the evening to "take the edge off."
Questions:
1. Based on the initial information provided, which of the following would be the most
appropriate first step in assessing Sarah's condition?
a) Administer the Beck Anxiety Inventory
b) Conduct a thorough clinical interview
c) Refer Sarah to a psychiatrist for medication evaluation
d) Suggest Sarah join a support group for anxiety
2. During the clinical interview, Sarah reveals that she experienced a panic attack during a
presentation at work last month. Which of the following questions would be most relevant to
ask next?
a) "Have you experienced similar episodes in other situations?"
, b) "Do you think your coworkers noticed your panic attack?"
c) "Have you considered changing jobs to reduce your stress?"
d) "Are you taking any medications for anxiety?"
3. Sarah discloses that she has been drinking more frequently in recent months. Which
assessment tool would be most appropriate to evaluate her alcohol use?
a) CAGE questionnaire
b) Michigan Alcohol Screening Test (MAST)
c) Alcohol Use Disorders Identification Test (AUDIT)
d) Blood Alcohol Concentration (BAC) test
4. Based on the information gathered, which of the following diagnoses would you consider as
a possible primary diagnosis for Sarah?
a) Major Depressive Disorder
b) Generalized Anxiety Disorder
c) Alcohol Use Disorder
d) Social Anxiety Disorder
5. When developing a treatment plan for Sarah, which of the following interventions would
likely be most beneficial as an initial approach?
a) Psychodynamic therapy to explore childhood trauma
b) Cognitive-Behavioral Therapy (CBT) for anxiety management
c) Family therapy to address relationship issues
d) Exposure therapy for public speaking anxiety
6. Sarah expresses concern about her alcohol consumption. Which of the following responses
would be most appropriate?
a) Suggest she attend Alcoholics Anonymous meetings
b) Provide psychoeducation on the effects of alcohol on anxiety
c) Recommend she stop drinking immediately
d) Refer her to an inpatient detox program
7. During a session, Sarah reveals that she has been having thoughts of "not wanting to wake
up." What is the most appropriate immediate response?
a) Explore the nature and frequency of these thoughts
b) Contact her emergency contact listed in her file
c) Suggest an immediate psychiatric hospitalization
d) Prescribe an antidepressant medication
8. Which of the following goals would be most appropriate to include in Sarah's initial treatment
plan?
a) Achieve complete abstinence from alcohol within one month
b) Return to pre-anxiety levels of work performance within two weeks
c) Develop and practice coping strategies for managing anxiety symptoms
d) Confront and resolve conflicts with all coworkers within one month
9. Sarah mentions that her company offers an Employee Assistance Program (EAP). How might
you incorporate this information into her treatment?
a) Suggest she use the EAP instead of continuing therapy with you
b) Explore how the EAP might complement her current treatment
c) Advise against using the EAP to maintain confidentiality
d) Require her to enroll in the EAP as a condition of treatment
, 10. After several sessions, Sarah reports improvement in her anxiety symptoms but continues to
have difficulty with public speaking at work. Which of the following interventions would be
most appropriate to address this specific concern?
a) Refer Sarah to a career counselor to explore job options with less public speaking
b) Implement gradual exposure exercises for public speaking situations
c) Suggest Sarah disclose her anxiety disorder to her employer
d) Increase the frequency of therapy sessions to three times per week
NCMHCE Practice Questions - Set 1 with
Explanations
Explanations:
1. Correct answer: b) Conduct a thorough clinical interview
Explanation: A clinical interview is the most appropriate first step as it allows the counselor to
gather comprehensive information about Sarah's symptoms, history, and current life
situation. This provides a foundation for further assessment and treatment planning.
2. Correct answer: a) "Have you experienced similar episodes in other situations?"
Explanation: This question helps determine if Sarah's panic attacks are limited to work
presentations or if they occur in other contexts, which is crucial for accurate diagnosis and
treatment planning.
3. Correct answer: c) Alcohol Use Disorders Identification Test (AUDIT)
Explanation: The AUDIT is a comprehensive screening tool that assesses alcohol
consumption, drinking behaviors, and alcohol-related problems. It's particularly useful for
identifying harmful drinking patterns before they become severe.
4. Correct answer: b) Generalized Anxiety Disorder
Explanation: Sarah's symptoms of persistent anxiety, difficulty concentrating, sleep problems,
and social avoidance align closely with the diagnostic criteria for Generalized Anxiety
Disorder.
5. Correct answer: b) Cognitive-Behavioral Therapy (CBT) for anxiety management
Explanation: CBT is an evidence-based treatment for anxiety disorders. It can help Sarah
identify and change negative thought patterns and develop coping strategies for managing
anxiety symptoms.
6. Correct answer: b) Provide psychoeducation on the effects of alcohol on anxiety
Explanation: Educating Sarah about how alcohol can exacerbate anxiety symptoms is an
appropriate first step. It allows her to make informed decisions about her alcohol use without
imposing a specific course of action.
7. Correct answer: a) Explore the nature and frequency of these thoughts
Explanation: It's crucial to assess the severity and nature of Sarah's thoughts before taking
any drastic actions. This exploration will help determine the level of risk and appropriate
interventions.
8. Correct answer: c) Develop and practice coping strategies for managing anxiety symptoms
Explanation: This goal is realistic, measurable, and directly addresses Sarah's primary
concern. It provides a foundation for managing her anxiety in various situations.
