Candidate Handbook for
State Licensure
National Clinical Mental Health Counseling Examination
™
(NCMHCE
®
)
3 Terrace Way Greensboro, NC 27403-3660
Tel: 336-482-2856 • Fax: 336-482-2852
[email protected] • cce-global.org
Copyright © 2024. National Board for Certied Counselors, Inc. (NBCC). All rights reserved. No part of this publication
may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy or
recording, or stored in any information and retrieval system, without permission in writing from NBCC.
Revised July 16, 2024
2
Table of Contents
Introduction
About NBCC
About Pearson VUE
Nondiscrimination Policy
Examination Administration
Holidays
Examination Purpose, Content, and Form
History of the Examination’s Development
Examination Purpose and Content
Measurement Focus and Target Population
Minimally Qualied Candidate
Examination Format
Case Studies
Eligibility Requirements
Registering for the Examination
Registration Process
Test Authorization Window and Registration Expiration
Failing to Report for an Examination
Examination Reregistration
Fees and Refund Policy
Scheduling an Examination
To Schedule Online
To Schedule by Telephone
Accommodations for Candidates With Disabilities
Examination Appointment Changes
Circumstances Resulting in Forfeiture of Examination Registration Fees
Personal Emergency, Inclement Weather, or Power Failure
Taking the Examination
In-Person Examination Administration (Pearson VUE Test Center)
Test Center Locations
Security Requirements
Additional Test Administration Restrictions
Examination Process
5
7
5
7
5
7
5
7
6
7
6
8
8
9
9
9
9
9
10
10
10
10
13
10
13
11
13
11
13
12
14
12
14
3
Online Examination Administration (OnVUE)
Identication Requirements
OnVUE Test Administration Requirements
Security Requirements
Testing Space Requirements
Additional Examination Administration Restrictions
Examination Process
Examination Rules and Requirements
Examination Materials Ownership
Following the Examination
Pass/Fail Score Determination
Score Verication Requests
Appealing Examination Results
Appendix A - Content Outline
Appendix B - NCMHCE Sample Case Study
Selected References
16
16
16
17
17
18
19
22
21
21
20
20
27
33
15
15
4
For More Information
All questions and requests for information about state licensure requirements should be directed to the
state licensing agency to which the candidate is applying.
All questions and requests for information about the NBCC examination program should be directed to:
Center for Credentialing & Education, Inc. (CCE)
State Agency Services Department
3 Terrace Way
Greensboro, NC 27403
Voice: 336-482-2856
Fax: 336-482-2852
Website: cce-global.org
All questions and requests for information about examination scheduling should be directed to:
Pearson VUE
5601 Green Valley Dr.
Bloomington, MN 55437
Voice: 866-904-4432
Website: pearsonvue.com
5
Introduction
The National Clinical Mental Health Counseling Examination (NCMHCE) is designed to assess the knowledge,
skills, and abilities determined to be important for providing effective counseling services. The NCMHCE is
a requirement for counselor licensure in many states. It is one of two examination options for the National
Certied Counselor (NCC) certication and also fullls the examination requirement for the Certied Clinical
Mental Health Counselor (CCMHC) specialty certication.
There are two options for examination delivery for the NCMHCE:
1. You can take the examination on its own, as part of the state licensure process, which will be covered
in this handbook.
2. You can take the examination as part of the National Certied Counselor (NCC) application. The
benet of taking the examination via this method is that it allows you to get a head start on earning
your professional credentials. For more information on this process, review the candidate handbook at
nbcc.org/assets/exam/handbooks/ncmhce_applicant_handbook_for_national_certification.pdf.
About NBCC
The National Board for Certied Counselors, Inc., and Afliates (NBCC) is internationally recognized as a
leading provider of national counselor credentialing examinations. All 50 states; the U.S. territories of Guam,
Puerto Rico, and the U.S. Virgin Islands; and the District of Columbia use NBCC examinations as part of their
counselor licensure requirements. NBCC administers its examinations through the Center for Credentialing &
Education (CCE), its test administration services provider.
About Pearson VUE
Pearson VUE is NBCC’s computer-based testing partner for the administration and scoring of the NCMHCE.
As an independent testing agency, Pearson VUE has test centers across the globe and is headquartered in
Minneapolis, Minnesota.
Pearson VUE provides two test delivery options for the NCMHCE:
• In-person administration, at a Pearson VUE test center.
• Internet-based (online) administration through Pearson VUE’s OnVUE platform. The examination
may be taken on a computer at home or in a private setting with a strong internet connection and
webcam. Strict security protocols are in place to ensure the integrity and security of the testing
process and examination content. For more information about the OnVUE process and system
requirements, visit nbcc.org/exams/administration.
Nondiscrimination Policy
NBCC does not discriminate against any candidate based on gender, race, creed, age, sexual orientation,
national origin, disability, or any other basis prohibited by law.
6
Examination Administration
Candidates can take the NCMHCE in-person at a Pearson VUE test center or online through Pearson VUE’s
OnVUE platform.
Candidates choosing the in-person administration at a Pearson VUE test center can make an appointment
during advertised business hours during the month-long, approved test authorization window.
Candidates choosing the online administration option through OnVUE can make an appointment during the
month-long, approved test authorization window.
Holidays
Examinations are not offered on the following holidays:
New Year’s Day
Martin Luther King, Jr. Day
Memorial Day
Juneteenth National Independence Day
Independence Day
Labor Day
Thanksgiving Day and the following Friday
Christmas Eve Day (Limited hours)
Christmas Day
7
Examination Purpose, Content, and Form
History of the Examination’s Development
The development of the NCMHCE in the early 1990s marked the expansion of counseling national certication
into the evaluation of the ability of counselors to apply core knowledge to clinical practice.
The American Mental Health Counselors Association (AMHCA) initially developed the Certied Clinical Mental
Health Counselor (CCMHC) and, after a number of years of administration of the credential, determined
that the credential could be strengthened and expanded by adding a national, standardized examination.
In the early 1990s, NBCC agreed to acquire the credential and invest in the development of an examination
to anchor the certication and align the application process with the profession’s foundational national
certication, the National Certied Counselor (NCC).
NBCC approached the development of the clinical certication examination with an intentional focus on
drawing from the common core knowledge of professional counselors. NBCC convened a committee of
subject matter experts (SMEs) to explore examination format and develop items built on the core knowledge
base of practicing counselors. This committee was led by psychometric experts with a deep knowledge of
counseling, uniquely positioned to frame an examination that reected the central clinical requirements of
counselors through real-world simulated cases.
Examination Purpose and Content
The NCMHCE measures an individual’s ability to apply and evaluate knowledge in core counselor skills
and competencies and to practice competently as a professional counselor. Specically, the examination
assesses an entry-level clinical mental health counselor’s ability to apply knowledge of theoretical and
skill-based tenets through response to clinical case studies. The case studies are designed to capture a
candidate’s ability to identify, analyze, diagnose, and develop plans for treatment of clinical concerns.
Measurement Focus and Target Population
See Appendix A for the NCMHCE Content Outline.
Minimally Qualified Candidate
The minimally qualied candidate (MQC) for the NCMHCE must have a graduate-level degree or higher from
a counseling program that has been accredited by the Council for Accreditation of Counseling and Related
Educational Programs (CACREP) or is administered by an institutionally accredited college or university.
The counseling degree program must contain courses in the following nine (9) requirement areas:
1. Human Growth and Development Theories in Counseling
2. Social and Cultural Foundations in Counseling
3. Helping Relationships in Counseling
4. Group Counseling Theories and Processes
8
5. Career Counseling and Lifestyle Development
6. Assessment in Counseling
7. Research and Program Evaluation
8. Professional Orientation to Counseling
Examination Format
The NCMHCE test format is composed of 11 case studies. Of the total number of multiple-choice questions,
100 will be scored, and one of the case studies will be unscored. The unscored narrative and questions
are used for generating item statistics for future test forms. Candidates will have a total test session of 255
minutes (4 hours and 15 minutes), as follows:
• Time to complete the Test Administration and Condentiality Agreement: 5 minutes
• Time to complete the testing tutorial (including sample case study): 10 minutes
• Time to complete the examination: 225 minutes
• One scheduled break (after fth case study): 15 minutes
Total Test Session Time: 255 minutes
Case Studies
The case studies on the new format of the NCMHCE are designed to replicate the actual work of a clinical
mental health counselor. Each case study will comprise one narrative and a range of 9–15 multiple-choice
questions. These questions will measure application and other higher cognitive levels as dened in the
Bloom’s Taxonomy classication framework.
Each case study will be distributed in three sections: initial intake summary and two subsequent counseling
sessions. Each of the sections will start with a piece of the narrative followed by a set of multiple-choice
questions. These multiple-choice questions are based on the content of the narrative and measure an entry-
level counselor’s ability to apply knowledge of professional practice and ethics, intake, assessment and
diagnosis, treatment planning, counseling skills and interventions, and core counseling attributes in a real-
world clinical mental health session. See Appendix B for an NCMHCE sample case study.
9
Eligibility Requirements
Candidates should review all relevant state licensing agency requirements concerning the licensure
application and eligibility process. The State Directory is located on the NBCC website at nbcc.org/search/
stateboarddirectory.
To maintain the integrity of NBCC and CCE examinations, ensure test security, and minimize the likelihood
that former Pearson VUE personnel taking an NBCC or CCE examination are exposed to test content,
all Pearson VUE employees and contractors, including test administrators and examination proctors, are
disqualied from taking any NBCC or CCE examination for any purpose during their employment or afliation
with Pearson VUE and for 2 years following separation from employment or afliation with Pearson VUE.
This disqualication period applies to Pearson VUE personnel who are involved with the development
or maintenance of NBCC/CCE examinations and/or the delivery of in-person or online NBCC/CCE test
administrations. Similarly, any individual who plans to take any NBCC or CCE examination within the next 2
years cannot serve as a proctor or test administrator for NBCC/CCE examinations.
Registering for the Examination
Registration Process
There are two options to register for the NCMHCE:
1. Online registration. To begin this process, visit cce-global.org and choose the “Credentialing
Gateway” tab.
This type of registration may take an additional 4 weeks to process. A money order for the amount
of the examination is the only acceptable form of payment with the paper registration.
Test Authorization Window and Registration Expiration
Upon completion of the examination registration, all candidates will be notied of their test authorization
window. Candidates failing to schedule and take the test within the approved authorization window will forfeit
all registration fees paid to take the examination. A separate registration fee will be required to reregister for
an examination.
Any request to extend the test authorization time period window is governed by the Testing Authorization
Periods and Extension Requests Policy, which can be reviewed on the NBCC/CCE website, located here.
Failing to Report for an Examination
Candidates who fail to report for an examination appointment will forfeit all registration fees paid to take the
examination. A separate registration and fee will be required to reregister for an examination.
10
Examination Reregistration
Candidates who do not take the NCMHCE within the test authorization window must complete a separate
registration and fee for reregistration.
Candidates who fail the examination may take the examination again after a 30-day window. A separate
registration and fee will be required for the examination reregistration. For assistance with reregistration,
please contact (336) 482-2856 or [email protected].
Fees and Refund Policy
Candidates must submit the appropriate fee to register for the examination. Online payments must be made
by credit card (VISA, MasterCard, or American Express). A money order made payable to NBCC must be
included with the paper registration form. Examination fees are not refundable or transferable and are forfeited
if the examination is not taken within the approved test authorization window.
Scheduling an Examination
After successfully registering for the examination, candidates will receive an Authorization to Test email
from Pearson VUE, which includes the Candidate ID number and test authorization dates. Upon receipt of
the Authorization to Test email, the candidate may then schedule an examination appointment online or by
telephone.
To Schedule Online
• Retrieve the Candidate ID number from the Authorization to Test email received from Pearson VUE.
• Navigate to home.pearsonvue.com/cce and select “Create Account.”
• Follow step-by-step instructions to select the examination program and register for an examination.
• Select a test appointment time.
To Schedule by Telephone
• Contact Pearson VUE at (866) 904-4432 to schedule an examination appointment.
• Pearson VUE is available from 7 am through 7 pm Central Time, Mondays through Fridays, for
scheduling purposes.
Candidates may only schedule an examination appointment with Pearson VUE upon receiving the
Authorization to Test email.
When scheduling an examination appointment, candidates should be prepared to conrm a location (for in-
person testing), communicate a preferred date and time for testing, and provide their Candidate ID number.
Pearson VUE uses this ID number only for identication purposes for maintaining candidate records. When a
candidate contacts Pearson VUE to schedule an examination appointment, the candidate will be notied of
the time to report for the in-person administration at the test center, or the online administration via OnVUE.
11
After scheduling the examination appointment, candidates will receive a Conrmation of Examination
Registration email from Pearson VUE to conrm the scheduled appointment. The Conrmation of Examination
Registration will include the registration ID, date, time, appointment length, test center location (if applicable),
and approved accommodation(s) (if applicable).
Accommodations for Candidates With Disabilities
NBCC and Pearson VUE provide reasonable and appropriate special examination accommodations
for individuals with disabilities. The existence of a disability does not automatically necessitate an
accommodation. Consistent with the Americans with Disabilities Act (ADA), a disability is a physical or mental
impairment that substantially limits a major life activity or bodily function.
Candidates requesting a special examination accommodation (SEA) must review the State Directory located
on the NBCC website at nbcc.org/search/stateboarddirectory for state-specic information concerning
SEAs. In most states, the state licensing agency is responsible for identifying and requiring the information
and documentation that candidates must submit in order to request accommodations. The state agency will
review the SEA request and make a decision approving or denying the requested SEA. All accommodation
approval determinations made by the state agency are subject to NBCC/CCE approval under the Special
Examination Accommodations Policy located on the NBCC website at nbcc.org/Assets/Policies/NBCC-
CCE_Special_Examination_Accommodations_Policy.pdf.
Only specic, limited accommodations may be available for those candidates opting for the OnVUE online
administration of the NCMHCE.
SEAs must be requested for each examination registration. A candidate may use the Accommodations
Request form nbcc.org/assets/exam/SEA-State-Licensure-Candidates-Form-active.pdf, or submit
substantially similar documentation in accordance with the requirements set forth in the Special Examination
Accommodations Policy.
Accommodations must be pre-approved by the relevant state licensing agency or NBCC/CCE before
scheduling the examination. If an examination is scheduled prior to receipt of written confirmation
of SEA approval, the candidate may forfeit their accommodation request and/or their scheduled
examination appointment time.
Candidates who receive written conrmation of SEA approval must schedule their examination appointment
by calling Pearson VUE’s toll-free number (800) 466-0450 and selecting Option 3.
For any questions related to accommodations, please feel free to contact:
Examination Appointment Changes
Candidates may reschedule their test up to 24 hours before the currently scheduled examination appointment
by contacting Pearson VUE at (866) 904-4432. Candidates with approved accommodations must call (800)
466-0450, and select Option 3, to reschedule their examination. A rescheduling fee of $50 will be charged to
the candidate.
12
Circumstances Resulting in Forfeiture of Examination Registration Fees
Examination registration fees and all fees paid to take the examination are forfeited when a candidate:
• misses an appointment and does not reschedule at least 24 hours before the examination
appointment.
• arrives more than 15 minutes late for an examination.
• violates any NBCC/CCE or Pearson VUE policy, rule, procedure, or instruction from a proctor or
examination administrator.
• engages in any prohibited conduct during the examination administration, such as conduct related to
cheating or a test security breach.
Personal Emergency, Inclement Weather, or Power Failure
In the event of a personal emergency or other circumstance that prevents the candidate from taking the
examination at the scheduled appointment time, the candidate is required to: promptly contact CCE at (336)
482-2856 or [email protected]; explain the circumstances resulting in the inability to test; submit
specic information and related documentation, if applicable, supporting the reason(s) and circumstance(s)
identied to CCE; and identify when the candidate is available to reschedule the examination. CCE, in its
sole discretion, will determine whether the candidate is permitted to cancel the current test appointment and
reschedule the examination, or is required to reregister to take the NCMHCE.
In the event of inclement weather, Pearson VUE will determine whether circumstances warrant the
cancellation and rescheduling of an examination appointment. An examination will usually be rescheduled if
the test center personnel are unable to open the facility. Every attempt is made to administer an examination
as scheduled; however, should an examination be canceled at a test center, all scheduled candidates will
receive notication by email or telephone regarding rescheduling or reregistration procedures.
During an OnVUE online NCMHCE administration, if the candidate experiences a power outage that
temporarily interrupts the administration of the examination, the NCMHCE will restart at the last question
completed. The candidate will need to log back in to restart the examination. Details about this process and
the steps a candidate must follow, including conducting a system test for software compatibility prior to
testing, are provided at home.pearsonvue.com/cce. Important FAQs and instructions are provided under the
“Learn More” tab of the Pearson VUE/CCE webpage.
13
Taking the Examination
In-Person Examination Administration
(Pearson VUE Test Center)
The examination will be delivered in-person, via computer-based testing, at a physical Pearson VUE test
center. Advanced computer experience or typing skills are not required to take the examination. On the day of
the NCMHCE appointment, the candidate can check in up to 30 minutes before the examination and up to 15
minutes after the scheduled appointment time. If the candidate checks in more than 15 minutes after the
scheduled testing time, the candidate will not be allowed to test and will forfeit their registration fee.
Note: The candidate must provide two forms of proper identication as part of the check-in process at
the test center, and at least one form of identication must be one of the following: driver’s license, state
ID, military ID, or passport. Failure to provide appropriate identication at the time of the examination is
considered a missed test appointment, and the candidate will forfeit their examination fee. For specific
information on identification requirements, please visit home.pearsonvue.com/Policies/1S/English.
Prior to testing at a Pearson VUE test center, the candidate is required to review and sign the Pearson VUE
Candidate Agreement before being allowed into the test center. The document explains what candidates must
do if they need help during the examination and identies other test administration policies.
Test Center Locations
Pearson VUE test centers have been selected to provide reasonable accessibility to candidates in all states
and U.S. territories. A current listing of Pearson VUE test centers, including addresses and driving directions,
is available at home.pearsonvue.com/nbcc under “Find a Test Center.”
Security Requirements
NBCC/CCE and Pearson VUE maintain the highest degree of test administration and security standards. All
test centers are monitored by audio and video surveillance equipment for security purposes.
The following security requirements apply during the in-person test administration:
• No cameras, notes, tape recorders, personal digital assistants (PDAs), pagers, cell phones, or smart
watches are allowed in the testing room.
• No calculators are permitted.
• No guests, visitors, or family members are allowed in the testing room or reception areas.
• No personal items, valuables, or weapons should be brought to the test center.
• A locker is provided for storing keys, wallets, and cell phones. Pearson VUE is not responsible for
items left in the reception areas.
NBCC/CCE or Pearson VUE may modify these security requirements as needed.
14
Additional Test Administration Restrictions
• Writing materials will be provided during check in.
• All writing materials must be returned to the proctor at the completion of testing, or a score report will
not be given.
• There will be a 15-minute break in the middle of the examination. Voluntary breaks may be taken
during the examination; however, the examination clock will not stop during any voluntary breaks.
Candidates must follow all Pearson VUE rules and procedures when requesting and taking a break.
Examination Process
Upon arrival at the test center, and following the check-in process, each candidate will be directed to a
testing carrel. All candidate testing sessions will be monitored by video throughout the entirety of the test
administration.
Candidates will have a total test session of 255 minutes (4 hours and 15 minutes), as follows:
• Time to complete the Test Administration and Condentiality Agreement: 5 minutes
• Time to complete the testing tutorial (including sample case study): 10 minutes
Following acceptance of the Agreement, each candidate will be provided with a 10-minute
examination tutorial that reviews how to navigate and respond to the test items. Upon completion of
the tutorial, candidates will begin the timed examination.
• Time to complete the examination: 225 minutes
• One scheduled break (after fth case study): 15 minutes
Total Test Session Time: 255 minutes
The clock does not stop and will continue to run during any unscheduled break taken by the candidate during
the test administration. Once the time has expired, the examination will terminate. A digital clock appearing
on the computer screen indicates the time remaining to complete the examination.
Only one examination question is presented at a time. The question number appears in the upper right portion
of the screen. Answer choices are identied as A, B, C, or D. The candidate chooses an answer by clicking
the option for the best response. To change an answer, the candidate simply clicks on the alternate option.
The candidate will have the opportunity to review their responses to each section of the case study before
moving to the next section. Once the candidate has continued to the next section of the case study, they will
neither be able to review nor change responses to prior sections. The candidate should therefore be sure
to address any agged or skipped questions before moving on to the next section. There is no limit on the
number of times the candidate may change their answer before moving on to the next section of the case
study. The candidate is encouraged to provide an answer for every examination question completing each
section, as there is no penalty for guessing.
15
Online Examination Administration (OnVUE)
The examination will be delivered via internet-based, online-proctored testing administered by Person VUE,
at an appropriate location selected by the candidate. Advanced computer experience or typing skills are not
required to take the examination. On the day of the examination appointment, the candidate can check in
up to 30 minutes before the examination and up to 15 minutes after the scheduled appointment time. If the
candidate checks in more than 15 minutes after the scheduled testing time, the candidate will not be
allowed to test and will forfeit their registration fee.
Prior to testing, the candidate is required to read and sign the Pearson VUE Candidate Rules Agreement.
The document outlines what test takers should do if they need help with the examination and other policies.
Identification Requirements
On examination day, candidates will be prompted to take a photo of their government-issued ID and a real-time
photo of themselves. Candidates will be required to show that same photo ID to the proctor via the webcam.
Before testing online, candidates will need to provide ID that meets the following requirements:
• All IDs must be valid (unexpired) government-issued originals (i.e., not a photocopy).
• IDs must include the candidate’s name and a recent, recognizable photo.
• The rst and last name on the ID must match the rst and last name used to register for the examination.
• Acceptable forms of ID:
o international travel passport
o driver’s license
o identication card (national or state ID card)
o alien registration card (green card or permanent resident/visa)
* Pearson VUE cannot accept restricted IDs—those prohibited by law from being photocopied, digitized, or
captured on camera—as identication for online testing.
Note: The candidate must have proper identication to test via internet-based, online-proctored testing.
Failure to provide appropriate identication at the time of the examination is considered a missed test
appointment, and the candidate will forfeit their examination fee.
Candidates with questions or concerns about the ID requirements should contact Pearson VUE customer
service at home.pearsonvue.com/Contact-Us.aspx.
16
OnVUE Test Administration Requirements
The candidate will be required to adhere to the following NBCC/Pearson VUE test administration policies and
rules with respect to internet-based testing:
Security Requirements
• Immediately prior to the start of their testing session, each candidate must run a computer system
check to ensure that the computer being used to complete the examination meets all Pearson VUE
computer system and technical requirements. Information concerning the systems check is available
at home.pearsonvue.com/cce/onvue. Failure to perform the system check may result in technical
deficiencies that could adversely affect a candidate’s test administration or ability to complete the
examination.
• Prior to accessing the examination, candidates will be required to show their testing space to the
online proctor via the computer webcam and capture four photos of their testing environment.
• Constant online proctoring/monitoring will be conducted by both artificial intelligence and a Pearson
VUE–certified proctor by webcam and microphone throughout the test administration.
• Computers used to take online examinations are not always protected from security threats by third
parties. In order to protect both the security and integrity of NBCC/CCE examinations, and the
candidate taking the test, Pearson VUE is constantly monitoring for unknown software, threatening
computer programs, unauthorized access to a candidate’s computer, and/or other potential security
risks. In the event any threat or risk is identified, a candidate will be prohibited from accessing the
examination and/or the examination will be revoked immediately, among other remedial actions. If a
candidate is denied access to an examination or their examination is revoked, the candidate should
contact NBCC/CCE at [email protected] for further information and instructions.
Testing Space Requirements
During the test administration, the candidate MUST:
• Be alone in the room. Other individuals (including children) and pets (except service animals) are not
allowed in the testing environment. It is recommended that candidates use a room with a locking door
to reduce the likelihood that an interruption will occur.
• Have a clear desk and testing area. The candidate is not permitted to have textbooks, cell phones,
smart watches, or other materials that may have test content or exam-related information in their
testing location, including bulletin boards, white boards, or other items.
• Be connected to a power source and the internet.
• Keep their webcam, speakers, and microphone on for the duration of the test. The proctor must
be able to see and hear the candidate throughout the test.
The candidate CANNOT:
• Use a phone or headphones.
• Use dual computer monitors.
17
• Leave their seat or get up for any reason, unless specically instructed by the proctor. A 15-minute
break will be offered to all candidates at the halfway point of the examination.
• Talk or read the test questions aloud.
Any interruption, including contact with any person other than the examination proctor, or any violation of
these test administration rules will result in termination of the online administration of the NCMHCE.
The proctor may provide other directives regarding the examination environment. Failure to follow any
instructions or directives from the proctor will result in termination of the examination and forfeiture of the test
appointment and NCMHCE registration fee.
Additional Examination Administration Restrictions
• Like the examination in the test centers, a 15-minute break will be offered to all candidates at the
halfway point of the examination. No additional test time will be given to candidates.
• Candidates may not eat or drink during the test administration, unless specically approved by the
state licensing agency and/or NBCC/CCE. Candidates may have water in a clear container during the
examination.
Examination Process
Candidates are encouraged to review the OnVUE test administration rules and procedures, which are
explained on the Pearson VUE website, located at home.pearsonvue.com/cce/onvue.
Upon accessing the secure examination, the candidate will be instructed to show the proctor a full view of the
testing area after the candidate’s identication has been conrmed. Candidates will be monitored by video
and audio throughout the examination session.
The candidate will review their candidate information to conrm that the information is accurate.
Candidates will have a total test session of 255 minutes (4 hours and 15 minutes), as follows:
• Time to complete the Test Administration and Condentiality Agreement: 5 minutes
• Time to complete the testing tutorial (including sample case study): 10 minutes
Following acceptance of the Agreement, each candidate will be provided with a 10-minute
examination tutorial that reviews how to navigate and respond to the test items. Upon completion of
the tutorial, candidates will begin the timed examination.
• Time to complete the examination: 225 minutes
• One scheduled break (after fth case study): 15 minutes
Total Test Session Time: 255 minutes
18
The examination will terminate if the time allowed is exceeded. A digital clock indicates the time remaining to
complete the examination.
Only one examination question is presented at a time. The question number appears in the upper right portion
of the screen. Answer choices are identied as A, B, C, or D. The candidate chooses an answer by clicking
the option for the best response. To change an answer, the candidate simply clicks on the alternate option.
The candidate will have the opportunity to review their responses to each section of the case study before
moving to the next section. Once the candidate has continued to the next section of the case study, they will
neither be able to review nor change responses to prior sections. The candidate should therefore be sure
to address any agged or skipped questions before moving on to the next section. There is no limit on the
number of times the candidate may change their answer before moving on to the next section of the case
study. The candidate is encouraged to provide an answer for every examination question completing each
section, as there is no penalty for guessing.
For security reasons, no unscheduled breaks will be permitted during the OnVUE test administration. If a
candidate anticipates needing additional breaks outside of the scheduled 15-minute break, the candidate is
strongly encouraged to test in-person at a testing center.
Examination Rules and Requirements
Regardless of test delivery format selected by the candidate (i.e., in-person or online test administrations),
candidates will be required to comply with all NBCC/CCE and Pearson VUE test administration policies, rules,
instructions, and security requirements, including the Pearson VUE Candidate Rules Agreement, which can be
reviewed on the following website: home.pearsonvue.com/Clients/CCE/Rules-Agreements.aspx.
Misconduct
Candidates must not engage in any prohibited conduct during the examination, including, but not limited to:
• Cheating
• Using any unauthorized materials or communication devices, such as cell phones, PDAs, smart
watches, or pagers
• Accessing other computer programs, applications, or content during the examination
• Communicating with other candidates or other persons during the test administration
• Being abusive to, or otherwise uncooperative with, the proctor and/or test administrator
• Interruptions where others enter or walk through the testing room
• Copying, or attempting to make copies of, any examination materials, including, without limitation,
any questions, answers, or screen images; this includes taking photos or videos of computer screens,
even if attempting to document a technical problem or other issue
• Attempting to take the examination for someone else
• Being observed with notes, books, or other aids
• Participating in any data dump activities (e.g., sharing specic test questions and content with others)
• Reading aloud or mouthing the questions and answer choices
• Looking around the room
• Taking an unauthorized break in test centers
19
• Taking an unscheduled break in the OnVUE examination
• Eating, chewing gum, smoking, or having a drink, other than water in a clear container
• Asking the proctor or examination administrator questions about the examination content
• Any other behavior deemed as misconduct or suspicious activity as reported by examination
administrators or proctors
If NBCC/CCE or Pearson VUE determines that a candidate has acted contrary to any applicable NBCC/
CCE or Pearson VUE test administration policy, rule, procedure, or instruction, or the terms of the Test
Administration and Condentiality Agreement, the candidate’s examination may be terminated and/or their
scores may be invalidated by NBCC. Additionally, a candidate may be subject to appropriate corrective
actions and/or sanctions, including, but not limited to, ineligibility for any future NBCC tests.
Examination Materials Ownership
The NCMHCE, including all test questions and answers, is condential and cannot be provided to any other
person(s). NBCC owns all rights, titles, and interests related to the NCMHCE and all examination-related
materials, including trademark and copyright interests and rights.
Candidates are prohibited from: copying, or attempting to make copies of any examination materials,
including, without limitation, any questions, answers, or screen images; disclosing, reproducing, using, or
transmitting any examination material, in whole or in part, in any form or by any means, verbal or written,
electronic or mechanical, for any purpose; and, reconstructing, or attempting to reconstruct, any NCMHCE
questions or answers from memory in any form, or discussing any of the content of the NCMHCE with any
other person(s). Candidates are strictly prohibited from taking photos or videos of any examination materials,
including but not limited to the content of the examination, even if attempting to provide documentation of a
technical problem or other issue.
20
Following the Examination
Upon completion of the examination, candidates will be asked to complete a short evaluation of their
examination experience. Test center candidates will then be instructed to report to the examination proctor
to receive an unofcial score report, which includes the candidate’s photograph. Candidates taking the
examination through OnVUE will be able to access their score report information from their dashboard. They
will log in to their Pearson account and select the View/Print Score Report option at the top right of the login
page. If this option is not available, they should contact Pearson’s customer service at 866-904-4432 to
request a copy.
Passing the examination does not guarantee state licensure. NBCC reserves the right to withdraw or
void ofcial scores if NBCC determines that a candidate engaged in any prohibited conduct during the
examination, including any violation of a NBCC/CCE or Pearson VUE policy, rule, procedure, or instruction.
Within 30 days of the end of the monthly test administration cycle, CCE will report ofcial scores to the
candidate’s state licensing agency after verifying that the candidate complied with all test administration
policies, rules, procedures, and instructions during the examination administration. Candidates should
contact their state licensing agency with any questions concerning the state licensure process.
Those candidates who do not pass the NCMHCE must wait 30 days to retake the examination unless a longer
time period between each retest is specically directed by the state licensing agency. A separate licensure
examination registration and fee must be submitted by each candidate applying for a retest.
Pass/Fail Score Determination
The examination score is determined only by the candidate’s performance on the test. It is important to note
that a candidate’s ability to pass the NCMHCE depends on the knowledge and skills of the candidate and not
on the performance of other candidates.
Within the 130–150 questions on each form of the NCMHCE, 100 of the questions are scored for the purpose
of determining whether the candidate meets the minimum criterion (passing) score for that test form. Each of
these 100 questions count for one score point; thus, the maximum possible score a candidate can achieve
is 100. The cut score (minimum passing score) for the NCMHCE is calculated through a standard-setting
process, which requires a committee of subject matter experts to review and evaluate each question on
the examination in order to determine the passing score that would be expected from a minimally qualied
candidate (MQC).
A process of statistical equating is used to determine the cut score for each version of the examination.
Statistical equating ensures fairness to all candidates by associating the cut score on a test form with the
difculty level of the items within the form. To ensure fairness, the cut score of each examination version will
vary slightly.
21
Score Verification Requests
Candidates can order an ofcial score report by submitting a Score Verication Request Form, with payment,
to NBCC/CCE. Score reports can be requested by completing the form available at: cce-global.org/Assets/
StateLicensureCandidates_score-verification-form.pdf. Completed forms can be mailed or faxed to
NBCC/CCE. Scores are reported to the entity identied by the candidate on the form in written format only
and not over the telephone, by email, or by fax. Candidates can also order their score report online in the
Credentialing Gateway.
Appealing Examination Results
In the event that a candidate wishes to appeal a failing test result, the candidate must satisfy the requirements
in the NBCC/CCE Examination Appeals Policy located on the NBCC website at nbcc.org/Assets/Policies/
NBCC_CCE_Examination_Appeals_Policy.pdf and complete all appeal submission requirements. Failure to
follow the appeal instructions identied in this Policy will result in rejection of the appeal.
A free retake of the examination is the only remedy for an accepted and approved appeal. The candidate’s
test score will not be changed or modied.
22
Appendix A
Content Outline
The examination’s development is based upon a national job analysis of more than 16,000 credentialed
counselors identifying empirically validated work behaviors determined to be most relevant for competent
counseling practice. The most recent job analysis was nalized in June 2019, and the test blueprint on the
Content Outline was nalized in 2021 by the NCMHCE subject matter experts.
The committee’s responsibilities included, but were not limited to, identifying components of the profession
and related job tasks and crafting survey items, and reviewing the format of the instrument to measure those
components and tasks.
Table 1 presents the six content domains and the percent of scored items in an NCMHCE on each of these
domains.
Table 1. The Weight of Each Domain
Domain Percent of items
1 Professional Practice and Ethics 15
2 Intake, Assessment, and Diagnosis 25
3 Areas of Clinical Focus 0
1
4 Treatment Planning 15
5 Counseling Skills and Interventions 30
6 Core Counseling Attributes 15
1
The domain “Areas of Clinical Focus” represents the diagnoses and main presenting problems that were
identied in the job analysis as being the most prevalent in clinical work. This domain is evaluated through a
variety of diagnoses and case scenarios appearing on each examination form and not at the item level.
Table 2 presents the knowledge, skills, and tasks under each domain of the Content Outline.
Table 2. Knowledge, Skills, and Tasks Related to the Domains
1. Professional Practice and Ethics
This section encompasses counselors’ knowledge, skills, and abilities related to maintaining proper
administrative and clinical protocols.
A. Assess your (the counselor) competency to work with a specic client
B. Understand statistical concepts and methods in research
23
C. Practice legal and ethical counseling
D. Clarify counselor/client roles
E. Discuss client’s rights and responsibilities
F. Discuss limits of condentiality
G. Explain counselor/agency policies
H. Review payment, fees, and insurance benets
I. Explain counseling processes, procedures, risks, and benets
J. Explain uses and limits of social media
K. Inform clients about the legal aspects of counseling
L. Obtain information consent
M. Discuss condentiality as it applies to electronic communication
N. Establish group rules, expectations, and termination criteria
O. Assess competency to provide informed consent
P. Monitor the therapeutic relationship and build trust as needed
Q. Review client records
R. Provide adequate accommodations for clients with disabilities
S. Provide information to third parties
T. Provide referral sources if counseling services are inadequate/inappropriate
U. Advocate for professional and client issues
V. Supervision
W. Create and maintain documentation appropriate for each aspect of the counseling process
X. Awareness and practice of self-care
2. Intake, Assessment, and Diagnosis
This section encompasses counselors’ knowledge, skills, and abilities to effectively conduct client intake,
assessment, and diagnosis.
A. Conduct a biopsychosocial interview
B. Conduct a diagnostic interview
C. Conduct cultural formulation interview
D. Conduct an initial interview
E. Determine diagnosis
F. Perform a Mental Status Exam (MSE)
G. Consider co-occurring diagnoses
H. Determine level of care needed
I. Determine the appropriate modality of treatment
J. Assess the presenting problem and level of distress
K. Evaluate an individual’s level of mental health functioning
L. Screen clients for appropriate services
M. Select, use, and interpret appropriate assessment instruments
N. Use formal and informal observations
O. Assess for trauma
P. Assess substance use
Q. Obtain client self-reports
R. Evaluate interactional dynamics
S. Conduct ongoing assessment for at-risk behaviors (e.g., suicide, homicide, self/other-injury, and
relationship violence)
T. Use pre-test and post-test measures to assess outcomes
U. Evaluate counseling effectiveness
24
3. Areas of Clinical Focus
This section encompasses counselors’ knowledge and skills related to areas of clients’ concern(s).
A. Adjustment related to physical loss/injury/illness
B. Aging/geriatric concerns
C. Behavioral problems
D. Bullying
E. Caregiving concerns
F. Cultural adjustments
G. End-of-life issues
H. Fear and panic
I. Financial issues
J. Gender identity development
K. Grief/loss
L. Hopelessness/depression
M. Loneliness/attachment
N. Hyper/hypo mental focus
O. Intellectual functioning issues
P. Insomnia/sleep issues
Q. Maladaptive eating behaviors
R. Remarriage/recommitment
S. Developmental processes/tasks/issues
T. Obsessive thoughts/behaviors
U. Occupation and career development
V. Physical issues related to anxiety
W. Physical issues related to depression
X. Physical/emotional issues related to trauma
Y. Process addictions (pornography, gambling)
Z. Racism/discrimination/oppression
AA. Religious values conict
AB. Retirement concerns
AC. Ruminating and/or intrusive thoughts
AD. Separation from primary caregivers
AE. Sexual functioning concerns
AF. Sleeping habits
AG. Spiritual/existential concerns
AH. Stress management
AI. Substance use/addiction issues
AJ. Suicidal thoughts/behaviors
AK. Terminal illness issues
AL. Visual/auditory hallucinations
AM. Worry and anxiety
AN. Adoption issues
AO. Blended family issues
AP. Child abuse-related concerns
AQ. Child development issues
AR. Dating/relationship problems
AS. Divorce
AT. Family abuse/violence (e.g., physical, sexual, emotional)
25
AU. Interpersonal partner violence concerns
AV. Marital/partner communication problems
AW. Parenting/co-parenting conicts
AX. Emotional dysregulation
4. Treatment Planning
This section encompasses counselors’ knowledge, skills, and abilities to develop an effective course of
treatment.
A. Collaborate with client to establish treatment goals and objectives
B. Establish short- and long-term counseling goals consistent with client’s diagnosis
C. Identify barriers affecting client goal attainment
D. Identify strengths that improve the likelihood of goal attainment
E. Refer to different levels of treatment (e.g., outpatient, inpatient, residential)
F. Refer to others for concurrent treatment
G. Guide treatment planning
H. Discuss termination process and issues
I. Discuss transitions in group membership
J. Follow up after discharge
K. Use assessment instrument results to facilitate client decision-making
L. Review and revise the treatment plan
M. Engage clients in review of progress toward treatment goals
N. Collaborate with other providers and client support systems (documentation and report writing)
O. Discuss with clients the integration and maintenance of therapeutic progress
P. Educate client to the value of treatment plan compliance
5. Counseling Skills and Interventions
This section encompasses counselors’ knowledge, skills, and abilities to conduct effective counseling.
A. Align intervention with client’s developmental level
B. Align intervention with counseling modality (individual, couple, family, or group)
C. Align intervention with client population (e.g., veterans, minorities, disenfranchised, disabled)
D. Implement individual counseling in relation to a plan of treatment
E. Establish therapeutic alliance
F. Apply theory-based counseling intervention(s)
G. Address addiction issues
H. Address cultural considerations
I. Address family composition and cultural considerations
J. Evaluate and explain systemic patterns of interaction
K. Explore family member interaction
L. Explore religious and spiritual values
M. Guide clients in the development of skills or strategies for dealing with their problems
N. Help clients develop support systems
O. Help facilitate clients’ motivation to make the changes they desire
P. Improve interactional patterns
Q. Provide crisis intervention
R. Educate client about transference and defense mechanisms
S. Facilitate trust and safety
T. Build communication skills
26
U. Develop conict resolution strategies
V. Develop safety plans
W. Facilitate systematic change
X. Provide distance counseling or telemental health
Y. Provide education resources (e.g., stress management, assertiveness training, divorce adjustment)
Z. Provide psychoeducation for client
AA. Summarize
AB. Reframe/redirect
AC. Facilitate empathic responses
AD. Use self-disclosure
AE. Use constructive confrontation
AF. Facilitate awareness of here-and-now interactions
AG. Facilitate resolution of interpersonal conict
AH. Use linking and blocking in a group context
AI. Management of leader-member dynamics
AJ. Model giving and receiving of feedback
AK. Address impact of extended families
AL. Contain and manage intense feelings
AM. Explore the inuence of family of origin patterns and themes
AN. Address the impact of social support network
AO. Use “structured” activities
AP. Promote and encourage interactions among group members
AQ. Promote and encourage interactions with the group leader
AR. Use psychoeducation as a part of the group process
AS. Explain phases in the group process
AT. Identify and discuss group themes and patterns
AU. Create intervention based on the stage of group development
AV. Challenge harmful group member behaviors
AW. Address the potential interaction of members outside of the group
6. Core Counseling Attributes
This section encompasses behaviors, traits, and dispositions of effective counselors.
A. Awareness of self and impact on clients
B. Genuineness
C. Congruence
D. Demonstrate knowledge of and sensitivity to gender orientation and gender issues
E. Demonstrate knowledge of and sensitivity to multicultural issues
F. Demonstrate conict tolerance and resolution
G. Empathic attunement
H. Empathic responding
I. Foster the emergence of group therapeutic factors
J. Non-judgmental stance
K. Positive regard
L. Respect and acceptance for diversity
M. Use foundational listening, attending, and reecting skill
NCMHCE Sample Case Study
27
Appendix B
NCMHCE Sample Case Study
Part One
Intake
Client
Age: 35
Gender: Female
Sexuality: Heterosexual
Ethnicity: White
Relationship Status: Single, Divorced
Counseling Setting: Agency
Types of Counseling: Individual
Provisional Diagnosis: Major depressive disorder, Single episode, Moderate, With anxious distress, Mild: F32.1
Presenting Problem:
You are a licensed mental health counselor working in a private practice setting. During the initial counseling
session, a 35-year-old divorced female, mother of two children aged 10 and 12, says she has come for
services because “I am in a rut and cannot nd a way out. I feel hopeless and I am not sure what to do with
my life.” Your client says the feelings of hopelessness began 6 months ago and the session with you is her
rst attempt at counseling. “I want to feel as condent and happy as I was when I rst met my ex-husband.
I was working full-time as a case worker and taking classes to be a nurse.” She is currently unemployed
but previously worked from home doing billing for a major insurance carrier. The client appears tearful and
expresses that she has felt like a failure since moving back in with her mother a year ago. “My kids are often
in trouble at school, and it got to a point where I couldn’t handle them on my own. So, I had to ask my mom
for help.” The client reports feeling sad and anxious since her divorce from her husband 3 years ago. “He left
me for a younger woman. I don’t know how I will make it without a spouse.” She feels sad, empty, and lonely
most days, disclosing, “I wake up feeling sad. I can’t remember the last time I enjoyed something.” Your client
reports her appetite has increased; she snacks throughout the day and has gained 15 pounds in the past 3
months. Your client reports that she used to create jewelry for fun and to supplement her income. However,
she stopped making craft jewelry and closed her online shop about 4 months ago because of fatigue and an
28
inability to concentrate. “After dealing with the kids, I just want to eat and go to bed.” Your client reports that
for the past 6 months she has been sleeping a couple of hours more than usual. She has asked her mother
to watch her children three to four nights a week because she is so fatigued. “I’m not able to spend as much
time with the kids as I did in the past, and when I am with them, I tend to zone out and can’t relax. I feel guilty.
I’ve ruined their lives.” Although she states that she has no desire to commit suicide and has no plan to harm
others, she does regularly think that everyone she knows would be better off without her. The only reason she
is going to counseling is because her mother “won’t stop bugging” her for staying in bed all day.
Mental Status Exam:
Your client presents with fair grooming and hygiene. Her hair is clean and brushed. She is dressed appropriately
for the weather in a gray sweatshirt and pants. She is alert and oriented to person, place, and time. The client’s at
affect is congruent with her sad and hopeless mood. The client’s long-term memories are within a normal range.
No abnormalities are noted in the client’s motor movements or gait. Her eye contact is good. The client’s thoughts
are cogent and linear. The client has difculty concentrating, and questions must be repeated several times during
the interview. The client’s thought content is focused primarily on harsh self- judgement, with an emphasis on
recollections of past failings. No delusions or hallucinations are noted. The client denies any thoughts of self-harm,
including ideas or plans to commit suicide. Client has not experienced a manic or hypomanic episode and denies
using alcohol or other substances.
Psychosocial and Family History:
Your client has one sister, 2 years younger, who lives out of state. The client’s parents are still married, though
her father lives in another state. Your client shares that she never felt valued in her family. She feels hopeless
around them because they question her ability to achieve anything worthwhile, including maintaining a job.
She denies any physical or sexual abuse or other trauma. Your client reports experiencing signicant nancial
difculties since her divorce, which was another reason that she moved in with her mother despite conicts in
the mother–daughter relationship. At the end of the intake, the client asks, “Will my mother have access to my
records because she pays for counseling?” You address the client’s concern about condentiality since her
mother has agreed to subsidize her counseling. You schedule the next session.
Domain 1. Professional Practice and Ethics
Sub-Domain 1.P. Monitor the therapeutic relationship and build trust as needed
1. During the intake, how would you establish a therapeutic relationship with this client?
A. Challenge her irrational thoughts about her self-evaluations.
B. Advise her about how to manage painful experiences.
C. Summarize her emotional struggles and desire for change.
D. Explore areas in which she could improve interpersonal relationships.
29
Domain 1. Professional Practice and Ethics
Sub-Domain 1.F. Discuss limits of confidentiality
2. How would you manage the client’s concern about condentiality?
A. Explain you will share whether or not the client is making progress but no details.
B. Use the informed consent process to discuss legal responsibilities and ethical
guidelines.
C. Request the mother consent to treatment and obtain the client’s consent.
D. Ask the client to include her mother in her treatment to address this concern.
Domain 2. Intake, Assessment, and Diagnosis
Sub-Domain 2.E. Determine diagnosis
3. What self-report from the client meets one of the supporting criteria for the diagnosis?
A. the client’s difculty with her children
B. the client’s job loss
C. the client’s inability to manage children
D. the client’s difficulty concentrating
Domain 2. Intake, Assessment, and Diagnosis
Sub-Domain 2.J. Assess the presenting problem and level of distress
4. Which criteria were used to determine the severity specier for the client’s major depressive
disorder?
A. number of symptoms is not substantially in excess of those needed to make the
diagnosis, yet functional impairment exists
B. the intensity of the symptoms is distressing, but manageable and result in minor impairment of
social or occupational functioning
C. the intensity of symptoms is high and is accompanied by psychomotor agitation and mixed
features associated with a major depressive episode
D. the number of symptoms and their intensity is distressing and unmanageable and interfere
with client’s social and occupational functioning
30
Domain 4. Treatment Planning
Sub-Domain 4.B. Establish short- and long-term counseling goals consistent with client’s diagnosis
5. What long-term goal would guide treatment of the client’s presenting problem?
A. Spend 1 hour each day focusing on what is going right in life.
B. Return to pre-marital levels, or better, for self-confidence and autonomy.
C. Decrease negative thoughts and feelings by half in 6 weeks.
D. Get out of bed before 8 am each morning.
Part Two
First session, 3 weeks after the intake session:
Your client arrives at the session on time. The client reports, “I feel about the same, not much has changed
for me.” The client shares that she applied for open job positions but has not performed well in interviews
because she is feeling so hopeless. She was turned down for three jobs for which she interviewed. Your
client states, “I must be a failure. I will probably never get a job, and me and my kids will end up living on
the streets.” In addition, she feels anxious and overwhelmed when she thinks about how she will take care
of her kids nancially in the future and states, “I worry a lot about paying the bills and feel like I will never
have enough money again to live on my own.” You provide empathy and educate the client on the tenets of
cognitive behavioral therapy (CBT) to challenge her thoughts and manage her feelings. In order to facilitate
her understanding of CBT, you ask the client to keep a journal of her thoughts and feelings.
Domain 5. Counseling Skills and Interventions
Sub Domain 5.F. Apply theory-based counseling interventions(s)
6. From a CBT perspective, how would you help your client reduce her feelings of anxiety?
A. Reect and summarize her feelings accurately.
B. Challenge your client’s ability to predict future outcomes.
C. Determine how she managed feelings about the future as a child.
D. Explore your client’s payoff for feeling anxious and overwhelmed.
Domain 5. Counseling Skills and Interventions
Sub-Domain 5.D. Implement individual counseling in relation to a plan of treatment
7. What cognitive error did the client make when disclosing not being hired for three jobs for which she
interviewed?
A. all-or-nothing thinking
B. personalizing
C. catastrophizing
D. minimizing
31
Domain 4. Treatment Planning
Sub-Domain 4.D. Identify strengths that improve the likelihood of goal attainment
8. What information from the case study would you explore to help the client remember her strengths?
A. Remind the client of the disclosure she made about her previous level of functioning.
B. Ask the client to recall of how she responded to job interviews.
C. Explore the client’s feelings of gratitude for her mother paying for counseling.
D. Praise the client for her ability to recognize cognitive errors in the session.
Domain 6. Core Counseling Attributes
Sub-Domain 6.M. Use foundational listening, attending, and reflecting skills
9. What nonjudgmental response would you make after the client’s disclosure about not being
selected for jobs?
A. “I am sorry they didn’t hire you and wonder what went wrong in the interview.”
B. “You feel upset about this experience, but you will learn from this situation.”
C. “We’ve all experienced this kind of rejection, even when we’re overqualied.”
D. “It sounds like the prospect of living with homelessness would be really scary for you.”
Part Three
Second session, 6 weeks after the intake session:
Your client arrives for the session on time. The client appears to be at a healthier weight, and it appears as
though her posture has improved a bit. She says she has cut down on “eating her feelings” and is paying
more attention to when she feels hungry. You praise her for this behavioral change. The client smiles at this
afrmation and says, “Yes, it hasn’t been easy. I am feeling more comfortable in my clothes, but I have a long
way to go. I’m still a whale!” The client reports that she has been keeping her journal and has recognized
patterns between her experiences and her feelings of hopelessness.” She reports that she feels the most
hopeless when she sees couples with their children. “I see that perfect little family and how great they are
doing, and I start crying. I don’t think I will nd another spouse and not having a father around is hurting my
kids. I am so upset about this that I can’t sleep some nights.” You validate the client’s experience and work
to build trust. You discuss cognitive distortions and examine cognitive errors the client has made during the
session and the impact these errors have had on her emotions.
Domain 6. Core Counseling Attributes
Sub-Domain 6.M. Use foundational listening, attending, and reflecting skills.
10. What counseling skill would you use to empathetically validate the client’s experience with how her
relationship with food inuences her behaviors and emotions?
32
A. Reflect the client’s feelings about her weight loss.
B. Assess the logic of the client’s claim that she is a whale.
C. Reframe the client’s statement to remind her she is capable of change
D. Challenge the meaning of the client’s statement about her weight loss.
Domain 5. Counseling Skills and Interventions
Sub-domain 5.F. Apply theory-based counseling intervention(s).
11. After validating the client’s feelings about her weight, what cognitive error would you bring to her
attention based on her statement?
A. selective abstraction
B. all-or-nothing thinking
C. minimizing
D. catastrophizing
Domain 5. Counseling Skills and Interventions
Sub-Domain 5.N. Guide clients in the development of skills or strategies for dealing with their problems
12. From a CBT perspective, what question would you ask to challenge the logic of the client’s belief
about her behavior being detrimental to her children?
A. “How would your children describe their life living with their grandmother?”
B. “What will your life look like if you nd a new husband and remarry?”
C. “What other steps have you taken to improve your situation?”
D. “How did you come to the conclusion that your children are being hurt?”
Domain 2. Intake, Assessment, and Diagnosis
Sub-Domain 2.G. Consider co-occurring diagnoses
13. Considering your client’s statements in both sessions after the intake about worry and stress, what
potential comorbid disorder warrants further assessment?
A. separation anxiety disorder
B. prolonged grief disorder
C. panic disorder
D. generalized anxiety disorder
Review the NCMHCE Content Outline for a full description of the examination development, content,
and weightage for each domain.
33
Selected References
NBCC does not endorse any study materials for the NCMHCE. The following references are presented as
potentially helpful options in preparing for the NCMHCE. Performance enhancement on the NCMHCE is
neither implied nor expressed.
American Counseling Association. (2014). ACA code of ethics. https://www.counseling.org/resources/aca-
code-of-ethics.pdf
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed.). Brooks/Cole Publishing
Company.
Hays, D. (2017). Assessment in counseling: procedures and practices (6th ed.). American Counseling
Association.
Wiger, D. E. (2012). The psychotherapy documentation primer (3rd ed.). Wiley & Sons.
The Professional Resources Department of the National Board for Certied Counselors and Afliates has
developed a preparation guide for the NCMHCE that includes a six-simulation sample examination with an answer
key and explanations for each choice. This guide can be purchased for $34.95 at nbcc.org/exams/examprep.
