Counselor Licensure Exam

Case-based practice · current format · updated Oct 30, 2026

NCMHCE practice test in the case format

55 questions in two parts. First come 16 single clinical items spread across the five domains, then four complete cases laid out like the sample case in NBCC's handbook (a header with the provisional diagnosis, an intake, then two later sessions). Answer a question and every option opens with its explanation; inside a case, the case text stays beside its questions.

Updated Oct 30, 2026 · Not affiliated with NBCC, CCE, AMFTRB, CRCC, ACA or AAMFT.

How to take it

Give yourself about 20 minutes per case: the exam allows 225 minutes for 11 cases, roughly 20 each. Four cases here make an 80-minute block, which is a fair dress rehearsal for one third of the real sitting.

  • Read the header before the narrative. The setting and the type of counseling (individual, family) narrow what a good answer can be.
  • Answer each part with what you know at that point. When a later part opens, its new facts apply only to the questions after it.
  • When an answer hinges on a word like first, best or most appropriate, look for the option that addresses safety or the information you still lack before the one that is merely helpful.

Single items, then four cases

Question 1 of 55 · Intake, Assessment, and Diagnosis · 25%

Which aspect of the mental status exam is most important to assess first when a client appears disoriented?

  1. Affect and mood are observed later; they cannot be judged reliably while the client's alertness is impaired.
  2. Thought content is assessed after alertness and orientation, since a clouded client cannot report it reliably.
  3. Level of consciousness comes first because every other part of the MSE depends on the client being alert, and reduced alertness points toward delirium or a medical emergency.
  4. Memory testing assumes the client is alert enough to attend; a clouded client fails it for reasons a memory test cannot separate.
Question 2 of 55 · Core Counseling Attributes · 15%

A client responds "yes, but" to every option you discuss together. Which approach best aligns with a nonjudgmental stance?

  1. Confronting the client about resistance frames the hesitation as opposition and tends to increase the pushback, the opposite of rolling with resistance.
  2. Labeling the pattern as defiance passes judgment on the client and turns ambivalence into a character flaw.
  3. Ignoring the pattern avoids judgment but also avoids the client; nonjudgment means exploring the pattern, not pretending it is not there.
  4. Accepting the hesitation and exploring it with curiosity treats "yes, but" as ambivalence worth understanding, which is what a nonjudgmental stance looks like in practice.
Question 3 of 55 · Core Counseling Attributes · 15%

You are counseling a Deaf client through an ASL interpreter. Where should your eye contact and speech be aimed?

  1. Speaking to the interpreter treats the interpreter as the client, a common error that sidelines the Deaf person in her own session.
  2. Splitting attention and asking the interpreter to summarize turns the interpreter into a go-between and loses the client's own words.
  3. Looking at your notes withdraws attention; she watches the interpreter for language but still reads your face and engagement.
  4. Looking at and speaking directly to the Deaf client, in the first person, keeps the relationship between counselor and client while the interpreter conveys the language.
Question 4 of 55 · Counseling Skills and Interventions · 30%

John, 15, has conduct disorder with truancy, fighting, and theft. Which treatment has the strongest evidence for him?

  1. Multisystemic therapy works with the family, school and peers in the youth's own environment and has the strongest evidence for adolescent conduct disorder.
  2. Individual insight-oriented therapy leaves out the family and school systems that maintain conduct problems and has weak evidence for them.
  3. Grouping youths who share conduct problems can increase antisocial behavior through peer contagion, often called deviancy training.
  4. Boot camps built on strict discipline do not reduce conduct problems and can worsen them.
Question 5 of 55 · Counseling Skills and Interventions · 30%

You are leading a 12-session cognitive-behavioral group for adults with social anxiety disorder. Which in-session activity is central to this approach?

  1. Silent meditation without work on anxious thoughts is not CBT; it leaves out both the exposure and the cognitive components.
  2. Interpreting the unconscious meaning of fears is psychodynamic work; CBT targets current thoughts and avoidance.
  3. Simulated exposures in session paired with cognitive restructuring are the core of cognitive-behavioral group therapy for social anxiety, as in Heimberg's model.
  4. Open discussion of childhood peer experiences is a process or psychodynamic group activity, not the structured focus of a CBT group.
Question 6 of 55 · Counseling Skills and Interventions · 30%

Ray, 35, has had two angry outbursts at work this month. You and Ray agree to develop a de-escalation plan for future situations. How would you develop the de-escalation plan?

  1. Building the plan with Ray from his own triggers and early warning signs makes it specific to him and gives him ownership, so he is more likely to use it.
  2. A standard template that ignores Ray's own triggers misses what sets off his outbursts, so it is unlikely to help when he needs it.
  3. Writing the plan yourself leaves Ray without ownership of it; plans made for clients rather than with them are followed less often.
  4. Asking his supervisor to design the plan discloses his counseling to his employer without consent and takes the work out of his hands.
Question 7 of 55 · Counseling Skills and Interventions · 30%

Mark's manager praised his presentation at a team meeting. In session, Mark says, 'Sure, it went well, but that was just luck. Anyone could have done it.' Which cognitive distortion is Mark showing?

  1. Calling the success luck that anyone could have managed is discounting the positive (disqualifying the positive in Beck's terms): good evidence is explained away.
  2. All-or-nothing thinking sorts things into two extremes; Mark's statement explains away a success instead.
  3. Mind reading assumes what others think; Mark accepts that his manager praised him and dismisses the praise himself.
  4. Overgeneralization draws a sweeping rule from one event ("I always fail"); Mark is not generalizing, he is dismissing a success.
Question 8 of 55 · Counseling Skills and Interventions · 30%

A client describes a harsh 'inner critic' that calls her worthless every time she makes a mistake. You are using a compassion-focused approach. What would you do?

  1. Arguing back harshly fights the critic with more hostility; CFT replaces the threat-based tone with warmth instead of matching it.
  2. Writing to herself as a caring friend would is a core compassion-focused exercise that builds a kind inner voice to answer the critic.
  3. Raising her standards feeds the self-criticism, since the critic attacks every mistake.
  4. Ignoring the critic is avoidance; compassion-focused therapy develops a compassionate response instead of suppressing the critic.
Question 9 of 55 · Intake, Assessment, and Diagnosis · 25%

Which method would you use to assess the range of a client's current support system?

  1. Counting friends seen each week measures one kind of contact and says nothing about the quality or variety of support.
  2. A record of professional supports covers formal services only and misses informal sources such as family, friends and a faith community.
  3. An ecomap diagrams the client's links to family, friends, work, community and services, showing the range and strength of each connection in one picture.
  4. A list of immediate family leaves out friends, community, work and agencies, so it cannot show the range of the client's supports.
Question 10 of 55 · Intake, Assessment, and Diagnosis · 25%

A client describes feeling "on top of the world" in one session and hopeless the next, with unclear dates. What would you do before settling on a diagnosis?

  1. Daily mood charting over several weeks gives the dates and durations needed to tell bipolar episodes from rapid mood shifts before a diagnosis is chosen.
  2. Diagnosing from the most severe episode you observed ignores duration criteria, which require dated episodes rather than snapshots from sessions.
  3. Jumping to borderline personality disorder from instability alone skips the history needed to rule out a pattern of mood episodes.
  4. Treating the depression without clarifying the highs risks missing bipolar disorder, and antidepressant-only treatment can trigger mania in bipolar clients.
Question 11 of 55 · Intake, Assessment, and Diagnosis · 25%

A 45-year-old client has worried about her job, health, and children for 8 months and has muscle tension, poor sleep, and irritability. Which feature marks her worry as generalized anxiety disorder rather than normal concern?

  1. Occasional sadness alongside worry says nothing about whether the worry is pathological; it is not a GAD criterion.
  2. Worry about several real-life topics happens in ordinary concern too; what defines GAD is that the worry is excessive and hard to control.
  3. GAD requires worry that is excessive and difficult to control for at least 6 months, with physical symptoms such as tension and poor sleep; normal concern is proportionate and controllable.
  4. Onset after a stressful event does not separate GAD from normal worry; an onset tied to a stressor points instead toward adjustment disorder.
Question 12 of 55 · Professional Practice and Ethics · 15%

You contacted a mobile crisis team to arrange an emergency evaluation for a client with imminent suicidal intent. What should you do regarding the disclosure you made?

  1. Telling her employer is a new disclosure with no emergency justification and no consent, which violates her confidentiality.
  2. Telling the client what was disclosed, and documenting what was shared, with whom and why, follows ACA B.2.e: reveal only essential information and keep the client informed when possible.
  3. Leaving an emergency disclosure out of the record is inaccurate documentation; a break of confidentiality to protect a client is recorded, not hidden.
  4. Sending the full case file goes beyond what the crisis team needs; disclosure in an emergency is limited to essential information.
Question 13 of 55 · Professional Practice and Ethics · 15%

An intern tells you she thinks bending ethical guidelines occasionally would let her try more creative interventions. What is the most appropriate supervisory response?

  1. Judging an ethics breach by its outcome is reasoning the code does not accept; a good result does not make a violation acceptable.
  2. Saving creative methods for private practice implies the code applies differently by setting; it applies wherever she practices.
  3. Encouraging her to test ethical limits with clients puts clients at risk; a supervisor's first duty is to protect client welfare.
  4. Discussing how creative methods can be used within the code supports her growth while keeping client welfare and the code in place, which is the supervisor's role.
Question 14 of 55 · Treatment Planning · 15%

A client with cocaine use disorder is committed to change one week and ambivalent the next. Which planning approach fits best?

  1. Psychoeducation alone gives information but does not work with the ambivalence behind his week-to-week shifts.
  2. Motivational strategies with flexible goals meet him where he is from week to week, which fits the shifting ambivalence typical of early change.
  3. A strict contract with firm consequences ignores his ambivalence and tends to provoke resistance or dropout.
  4. Waiting for consistent motivation treats it as a precondition, when building motivation is part of the treatment.
Question 15 of 55 · Treatment Planning · 15%

A client with schizophrenia wants to return to part-time work. Which planning approach best reflects recovery-oriented practice?

  1. Limiting goals to symptoms and hospitalizations ignores the functional and personal goals that define recovery.
  2. Client-directed goals about work and quality of life reflect recovery-oriented practice, which centers the person's own aims, here his return to part-time work.
  3. Making adherence the goal above all treats medication as the end point; recovery-oriented care treats it as one tool for the client's own goals.
  4. Goals decided mainly by the team are the traditional medical model that recovery-oriented practice replaces with shared decisions.
Question 16 of 55 · Treatment Planning · 15%

A 16-year-old with ADHD, combined presentation, sees a pediatrician for medication, has a school 504 plan, and sees you for weekly counseling. His parents signed releases for all three. How would you document these concurrent services in his treatment plan?

  1. Stating each provider's role and how often updates will be shared documents the coordinated care that the signed releases make possible.
  2. The 504 plan is a central part of his ADHD care; leaving school services out loses the setting where many of his symptoms show.
  3. Listing names without roles leaves the plan unclear about who is responsible for what, which defeats the purpose of coordination.
  4. A note that "multiple services are involved" gives no usable information about who does what or how care is coordinated.
Case 1Intake · questions 17–26Part 1 of 3

Intake

Age: 41 · Gender: Female · Sexuality: Heterosexual
Ethnicity: Black/African American · Relationship status: Married
Setting: Community mental health agency · Counseling: Individual
Provisional diagnosis: Posttraumatic stress disorder: F43.10

You are a licensed clinical mental health counselor at a community mental health agency. Danielle, a 41-year-old emergency department nurse, was referred by her hospital's employee assistance program (EAP). Seven weeks ago, during a night shift, a patient grabbed her by the throat and choked her until security staff pulled him away.

Since then she has had nightmares about the attack three or four nights a week, and she startles at monitor alarms. She traded her night shifts for daytime clinic work so she would not have to walk past the room where it happened. "I keep replaying it. I've been a nurse for 18 years. I should have seen it coming." She feels "cut off" from her coworkers and has stopped going to the unit's Friday lunch.

Her husband has told her that she snaps at their two teenagers over small things. She now drinks three or four glasses of wine most evenings "to shut my brain off." Before the assault she had a glass on weekends. She denies blackouts, morning drinking and withdrawal symptoms.

She is well groomed, alert and oriented ×4, with speech of normal rate and volume. She sits facing the door and startles when a door closes in the hallway. Her mood is "on edge," and her affect is anxious and congruent. Her thought process is linear. She denies suicidal and homicidal ideation and hallucinations, and she has never been in counseling.

Near the end of the intake she asks, "Does the EAP get a copy of what I say in here? My manager set this up."

Case 1 · Question 1 of 10 · Intake, Assessment, and Diagnosis · 25%

Which information from the intake distinguishes PTSD from acute stress disorder?

  1. Nightmares about the assault are an intrusion symptom found in both acute stress disorder and PTSD, so they do not separate the two.
  2. Seven weeks of symptoms is the deciding fact: acute stress disorder covers 3 days to 1 month after the event, and PTSD requires a duration of more than 1 month.
  3. Direct exposure to threatened death meets the stressor criterion of both diagnoses, so it cannot tell them apart.
  4. Avoiding the room where it happened is an avoidance symptom listed for both diagnoses, so it does not distinguish them.
Case 1 · Question 2 of 10 · Intake, Assessment, and Diagnosis · 25%

What is the most appropriate next step regarding her evening drinking?

  1. A detoxification referral is a higher level of care than the data support: she has no withdrawal signs, blackouts or morning drinking.
  2. Adding an alcohol use disorder diagnosis now is premature, because the intake does not yet establish two or more criteria within 12 months.
  3. Making sobriety a condition of trauma work is an ultimatum before rapport and assessment; co-occurring PTSD and drinking are better treated together.
  4. Screening with the AUDIT gives a structured picture of the drinking, and linking it to sleep and intrusive memories shows its function as self-medication.
Case 1 · Question 3 of 10 · Professional Practice and Ethics · 15%

How should you respond to her question about the EAP?

  1. A signed release is what allows anything to reach the EAP, and informed consent includes the legal exceptions such as danger to self or others and a court order.
  2. A progress summary to the EAP would breach confidentiality: a referral source has no right to clinical content without the adult client's authorization.
  3. Promising that nothing will ever be shared is inaccurate, because confidentiality has legal limits she needs to hear about now.
  4. Presenting a release for the EAP as a standard part of counseling makes it sound required; whether to sign one is her choice.

Part 1 of 3 · 0 of 3 answered

Part two · First session, 2 weeks after the intake

Her baseline PCL-5 score was 52, and she agreed to keep a log of her drinking. Today she describes the assault in a flat voice, then says, "If I were a better nurse, I would have read him earlier. It's my fault." You have started cognitive processing therapy (CPT) and introduced the idea of "stuck points."

Case 1 · Question 4 of 10 · Counseling Skills and Interventions · 30%

From a CPT perspective, how should you respond to her statement that the assault was her fault?

  1. Retelling the assault in the present tense and listening to the recording is imaginal exposure from prolonged exposure therapy, a different protocol.
  2. Reassuring her that nobody could have predicted it closes the topic, so the self-blaming belief is never examined.
  3. Socratic questions about what she knew then are the CPT tool for a self-blame stuck point; they expose hindsight bias without arguing with her.
  4. Exploring early relationships is a psychodynamic move that does not address the current stuck point CPT targets.
Case 1 · Question 5 of 10 · Intake, Assessment, and Diagnosis · 25%

How should an AUDIT score of 9 be interpreted for a client like her?

  1. Low-risk drinking matches scores below 8, and her intake already shows a sharp rise in use, so ignoring a score of 9 would be a mistake.
  2. Hazardous drinking is the range a score of 8 to 15 points to; in the WHO AUDIT guidance the response is brief advice about cutting back.
  3. Possible dependence is suggested by scores of 20 or more, and she reports no withdrawal symptoms.
  4. A screening result alone cannot confirm alcohol use disorder; a diagnosis needs a criteria-based assessment.
Case 1 · Question 6 of 10 · Treatment Planning · 15%

Which is the best-written short-term objective for her treatment plan?

  1. Feeling less anxious and more like herself is a hope, not an objective: it has no measure and no time frame.
  2. Fully processing the assault is a broad long-term aim with no measure or date to show when it is met.
  3. Delivering 12 sessions of CPT describes the counselor's intervention, not a change in the client.
  4. A PCL-5 drop of 10 points within 8 weeks is measurable, time-limited and about her own change, which is what an objective needs.

Part three · Sixth session, 8 weeks after the intake

Her PCL-5 score is now 38. The nightmares wake her about once a week, and she has cut back to two glasses of wine on weeknights. She wants to return to night shifts next month but still takes the long way around the room where she was attacked. She also mentions that her pastor told her to "forgive him and move on." "Maybe I'm just not a forgiving person," she says.

Case 1 · Question 7 of 10 · Counseling Skills and Interventions · 30%

Which approach best supports her goal of returning to night shifts?

  1. Staying on day shifts until symptoms resolve keeps the avoidance in place, and avoidance maintains PTSD.
  2. Returning to full night shifts at once is flooding without a plan or her agreement on the steps, and it risks a setback.
  3. A graded plan for approaching the room is in vivo exposure: each step lets her fear decrease without escape, which reverses the avoidance.
  4. Asking for a sedative before shifts is a medication recommendation outside the counselor's scope, and it would support avoidance.
Case 1 · Question 8 of 10 · Core Counseling Attributes · 15%

How should you respond to her comment about forgiveness?

  1. Exploring what forgiveness means in her faith respects her religious framework and lets her decide how it fits her recovery.
  2. Telling her forgiveness is not required replaces her faith's view with the counselor's own.
  3. Suggesting a break from her pastor cuts her off from a support she values and imposes the counselor's judgment.
  4. Agreeing that forgiving him would ease her symptoms endorses one side of a question she is still working out.
Case 1 · Question 9 of 10 · Counseling Skills and Interventions · 30%

Which intervention targets her remaining nightmares most directly?

  1. Sleep hygiene education alone helps general sleep habits but does not change the content of trauma nightmares.
  2. Dream interpretation looks for hidden meaning; it is not an evidence-based treatment for trauma nightmares.
  3. Progressive muscle relaxation at bedtime can lower arousal, but on its own it does not target the nightmares.
  4. Imagery rehearsal changes the nightmare script and practices it during the day; it is the best-supported psychological treatment for trauma nightmares.
Case 1 · Question 10 of 10 · Treatment Planning · 15%

What should you do with the treatment plan at this point?

  1. Reviewing progress on each objective with her uses the outcome data to set the next phase, such as the return to nights.
  2. Closing the case ignores her remaining avoidance and nightmares; a falling score is a reason to review, not to end.
  3. Keeping the plan unchanged ignores the new data; a plan is revised as goals are met or change.
  4. Referring her out is not supported: a 14-point drop shows she is responding to the current treatment.
Case 2Intake · questions 27–36Part 1 of 3

Intake

Age: 29 · Gender: Male · Sexuality: Gay
Ethnicity: Korean American · Relationship status: Single
Setting: Private practice · Counseling: Individual
Provisional diagnosis: Bipolar II disorder, current episode depressed, moderate: F31.81

You are a licensed mental health counselor in a private practice. Jae, a 29-year-old doctoral student in chemistry, was referred by his primary care physician, who started him on sertraline 5 months ago for depression.

For the past 3 weeks he has felt "heavy and slow." He sleeps 10 hours a night and misses lab meetings. "I can't even answer an email."

When you ask about times he felt the opposite, he describes "a great week" last spring. For about 5 days he slept 3 to 4 hours a night without feeling tired, redesigned his whole dissertation plan and spent $2,000 on equipment for a side project. His roommate told him he was "talking a mile a minute." He kept working and was never hospitalized. A similar stretch happened two years earlier. His father had "mood problems" that were never diagnosed.

He is casually dressed and oriented ×4. His speech is slow, and his affect is constricted and congruent with a depressed mood. He says that "it would be easier not to wake up" but denies intent, a plan or past attempts. He drinks rarely.

Case 2 · Question 1 of 10 · Intake, Assessment, and Diagnosis · 25%

Which information supports bipolar II disorder rather than major depressive disorder?

  1. Sleeping 10 hours and missing meetings describes the current depressive episode, which fits major depressive disorder just as well.
  2. His father's mood problems raise his risk, but family history is not a diagnostic criterion.
  3. A 5-day period of decreased need for sleep, increased activity and pressured speech noticed by others is a hypomanic episode, which with a depressive episode defines bipolar II.
  4. The onset before sertraline matters for ruling out a medication-induced episode, but it does not establish hypomania.
Case 2 · Question 2 of 10 · Intake, Assessment, and Diagnosis · 25%

What is the most appropriate response to his statement that "it would be easier not to wake up"?

  1. Recording it and waiting leaves passive ideation in a mood disorder unassessed; it calls for a structured assessment now.
  2. A structured assessment such as the C-SSRS covers ideation, intent, plan, behavior and protective factors, and a written safety plan gives him steps and contacts, including 988.
  3. An inpatient evaluation is not the least restrictive option: he denies intent, a plan and past attempts.
  4. A no-harm contract is not evidence-based and does not replace assessment or safety planning.
Case 2 · Question 3 of 10 · Treatment Planning · 15%

He agrees with the provisional diagnosis. What should you do about his current medication?

  1. Advising him to stop sertraline, even with his consent, is a medical recommendation outside the counselor's scope, and stopping abruptly can cause harm.
  2. Leaving medication out of counseling confuses prescribing with coordination; withholding relevant history from the prescriber is a gap in care.
  3. Sharing the hypomanic history with the prescriber after a release is care coordination, and it matters because antidepressant monotherapy carries risk in bipolar disorder.
  4. Saying antidepressants cause bipolar disorder is inaccurate, and it is still a medical recommendation.

Part 1 of 3 · 0 of 3 answered

Part two · First session, 2 weeks after the intake

A psychiatrist has started him on a mood stabilizer and is tapering the sertraline. He says he read about bipolar disorder online. "So I'm the crazy one in the family now. My parents already struggle with me being gay. This will prove them right." He looks at the floor. Later he mentions that he stays up until 3 a.m. on weekends to catch up on data analysis and sleeps until noon.

Case 2 · Question 4 of 10 · Core Counseling Attributes · 15%

Which response to his statement about his parents best conveys empathy?

  1. This reflection names both the feeling and its meaning, the fear of another label from a family that already struggles with his identity.
  2. Saying there is no reason to worry is premature reassurance that dismisses what he just shared.
  3. Pointing to successful people normalizes the diagnosis but skips his own experience of it.
  4. Turning to the research is psychoeducation that moves away from the emotion he has just disclosed.
Case 2 · Question 5 of 10 · Counseling Skills and Interventions · 30%

Which intervention best targets his weekend sleep pattern?

  1. Treating late nights as a reward keeps the irregular sleep that can trigger hypomania.
  2. Exploring the roots of his perfectionism is insight work that leaves the weekend sleep disruption, a known trigger of mood episodes in bipolar disorder, untouched.
  3. Sleeping in on Sundays shifts his rhythm further; catch-up sleep is the pattern to change.
  4. Keeping sleep and wake times regular is the core of interpersonal and social rhythm therapy; stable rhythms protect against new mood episodes.
Case 2 · Question 6 of 10 · Counseling Skills and Interventions · 30%

Later he says, "Bipolar means I'll never finish my PhD." What is the best response?

  1. Assuring him he will finish is a promise the counselor cannot make, and it leaves the belief untested.
  2. Asking about evidence for and against the thought is cognitive restructuring: he examines the prediction instead of accepting it.
  3. Suggesting a leave acts on the catastrophic prediction rather than examining it.
  4. Exploring his father's education moves away from the thought he just voiced.

Part three · Fourth session, 7 weeks after the intake

His mood has lifted. This week he slept 4 hours on two nights and felt "wired," with ideas for three new papers. "Part of me misses the highs. I got so much done." He also tells you he will spend 3 weeks at a summer lab in another state next month and would like to keep meeting by video.

Case 2 · Question 7 of 10 · Intake, Assessment, and Diagnosis · 25%

Which development would require changing the diagnosis to bipolar I disorder?

  1. Elevated mood lasting a week with marked impairment, or any length if he needs hospitalization, is a manic episode, and one manic episode changes the diagnosis to bipolar I; a high without marked impairment would still be hypomania.
  2. Another 4-day hypomanic episode is consistent with bipolar II and does not change the diagnosis.
  3. A second depressive episode fits the existing bipolar II diagnosis; only mania makes it bipolar I.
  4. Passive suicidal thoughts call for a new risk assessment, but they do not change the bipolar type.
Case 2 · Question 8 of 10 · Treatment Planning · 15%

Given the two short nights and the "wired" feeling, what should be added to his plan?

  1. Channeling the energy into work treats an early warning sign as an opportunity and can feed the episode.
  2. Fewer sessions as warning signs appear lowers support at the point of highest risk, even though the depressive episode has lifted.
  3. A relapse-prevention plan names his early warning signs and the steps and contacts for each, so a shift is caught early.
  4. Inpatient care is far more restrictive than two short nights warrant.
Case 2 · Question 9 of 10 · Counseling Skills and Interventions · 30%

How should you respond when he says, "Part of me misses the highs"?

  1. A warning about stopping medication is a confrontation that invites him to defend the highs.
  2. Exploring both sides of his ambivalence, the appeal of the highs and their costs, builds his own motivation to protect his stability.
  3. Agreeing that the highs are a strength endorses hypomania as a goal.
  4. Moving on to scheduling misses a known risk factor for stopping treatment.
Case 2 · Question 10 of 10 · Professional Practice and Ethics · 15%

What should you do about his request to continue by video from the other state?

  1. Practice is regulated where the client is located, so the counselor's home license may not cover sessions in another state.
  2. Pausing with no crisis plan leaves a client with recent warning signs without support.
  3. Text messaging still needs informed consent about its risks, and it does not solve the jurisdiction question.
  4. Practice is regulated in the state where the client is located, so you check that your license, that state's rules or a compact privilege covers sessions there.
Case 3Intake · questions 37–46Part 1 of 3

Intake

Age: 52 · Gender: Female · Sexuality: Heterosexual
Ethnicity: White · Relationship status: Divorced
Setting: Group practice, telehealth · Counseling: Individual
Provisional diagnosis: Generalized anxiety disorder: F41.1

You provide video counseling for a group practice. Carol, a 52-year-old insurance claims adjuster, has cared for her mother, who has Alzheimer's disease, in her own home for 2 years. She joins the intake from her car in the driveway, "the only private place I have."

She says she worries "about everything": her mother wandering at night, money, her son's new job, and whether she made a mistake on a claim. She has worried this way on most days for at least 18 months, and she cannot "turn it off." She reports tight shoulders, irritability, fatigue and trouble concentrating at work. For the past 8 months it has taken her over an hour to fall asleep on most nights, and she wakes at 3 a.m. even on nights when her mother sleeps through. She drinks four cups of coffee a day and takes an over-the-counter sleep aid. Her primary care provider ruled out a thyroid condition last month.

She appears tired and fidgets with a pen. Her speech speeds up when she talks about money. Her mood is "frazzled," and her affect is anxious. Her thought process is circumstantial at times. She denies suicidal and homicidal ideation, and her insight is good. Her GAD-7 score is 16.

Case 3 · Question 1 of 10 · Intake, Assessment, and Diagnosis · 25%

Which information best supports GAD rather than an adjustment disorder?

  1. Worry across many topics for 18 months meets the GAD pattern of excessive, hard-to-control worry for 6 months or more, beyond one stressor.
  2. Linking the worry to taking over her mother's care is the stressor-bound pattern that would point toward an adjustment disorder.
  3. Ruling out a thyroid condition is a medical rule-out needed for any anxiety diagnosis; it does not separate GAD from adjustment disorder.
  4. Irritability and tension appear in both conditions, so they do not decide between them.
Case 3 · Question 2 of 10 · Intake, Assessment, and Diagnosis · 25%

How should you account for her sleep problem in the assessment?

  1. Counting it only as a GAD symptom skips an assessment the data call for: she wakes even when her mother sleeps, so caregiving and worry may not explain it.
  2. Diagnosing sleep apnea is a medical diagnosis outside the counselor's scope, and early waking alone does not suggest it.
  3. A sleep diary shows the pattern, and insomnia that persists on its own for months can be diagnosed alongside GAD when it warrants separate attention.
  4. Attributing it to caregiving ignores that she wakes on nights when her mother sleeps through.
Case 3 · Question 3 of 10 · Professional Practice and Ethics · 15%

Which practice is most important for her video sessions?

  1. Insisting on a room with a closed door ignores her situation; privacy is planned with her, not imposed as a condition of the session.
  2. Confirming her location and an emergency plan each time lets you act in a crisis and know which state's rules apply to the session.
  3. Moving to the phone is not required: a parked car can be a private setting if she chooses it and the risks are reviewed.
  4. Skipping the location check assumes her location; it should be confirmed at every session.

Part 1 of 3 · 0 of 3 answered

Part two · Second session, 3 weeks after the intake

Over the past two weeks she spent about 9½ hours in bed each night but slept about 6. She spends up to 2 hours each evening "going over plans" for every possible problem and calls her sister for reassurance most nights. Her mother fell last week. Carol has looked at an adult day program but says, "A good daughter doesn't hand her mother off to strangers."

Case 3 · Question 4 of 10 · Counseling Skills and Interventions · 30%

Based on what she reports about her nights, which intervention fits best?

  1. Going to bed earlier adds more time awake in bed, which strengthens the insomnia.
  2. Alcohol before bed fragments sleep later in the night and adds a new risk.
  3. Staying in bed awake when she cannot sleep teaches the bed to signal wakefulness; stimulus control asks her to get up instead.
  4. Restricting time in bed to her actual sleep time is sleep restriction from CBT for insomnia; it builds sleep drive and consolidates sleep.
Case 3 · Question 5 of 10 · Counseling Skills and Interventions · 30%

Which technique best targets her nightly hours of "going over plans"?

  1. A scheduled worry period with postponement limits worry to a set time and shows her that worry can be delayed.
  2. Stopping each thought is thought suppression, which tends to make intrusive worries come back more often.
  3. Nightly reassurance from her sister brings short relief but maintains the worry cycle.
  4. Exploring childhood responsibility is insight work that leaves the nightly worry habit in place and gives her nothing to do differently in the evening.
Case 3 · Question 6 of 10 · Core Counseling Attributes · 15%

Which response to her comment about being a good daughter best conveys empathy?

  1. Telling her there is no reason to feel guilty dismisses the feeling she just expressed.
  2. Telling her to care for herself first is advice that skips her experience.
  3. A "why do you feel you need to" question can sound like a challenge and puts her on the defensive.
  4. This reflection names how much caring for her mother means and why accepting help feels like letting her down, without arguing with her.
Case 3 · Question 7 of 10 · Treatment Planning · 15%

Which referral fits her treatment goals best now?

  1. Requesting a specific medication is outside the counselor's scope, and benzodiazepines are not a first-line answer for her pattern.
  2. Inpatient care is not warranted: she is safe, working and engaged in outpatient counseling.
  3. A caregiver support group and respite services address the load that feeds her worry and sleep loss.
  4. Family therapy with a mother who has Alzheimer's disease is not a realistic way to meet Carol's goals.

Part three · Sixth session, 10 weeks after the intake

Her GAD-7 score is now 9. She sleeps about 6½ hours and spends 7 in bed. Her mother attends the day program two days a week. Carol would like to meet every other week. She also says her employer's insurance shows diagnoses on claims statements, and she asks whether you could bill for "insomnia only" so no one at work sees the word "anxiety."

Case 3 · Question 8 of 10 · Intake, Assessment, and Diagnosis · 25%

Her GAD-7 score has gone from 16 to 9. How should you interpret this change?

  1. A screening score cannot rule a diagnosis in or out; discharge depends on her goals and a clinical review.
  2. A score of 16 falls in the severe range and 9 in the mild range, and a 7-point drop is a meaningful change.
  3. A 7-point drop is larger than the change usually seen as meaningful on this measure.
  4. Moderate anxiety starts at 10, and an improving score does not call for a higher level of care.
Case 3 · Question 9 of 10 · Professional Practice and Ethics · 15%

How should you respond to her billing request?

  1. Billing insomnia alone to hide the GAD diagnosis misrepresents the services to the insurer.
  2. The diagnosis on a claim must reflect your assessment, so billing a partial picture is not an option; her worry about privacy can be discussed openly, including self-pay.
  3. Recording one diagnosis and billing another is fraudulent documentation.
  4. Health plans generally may not pass a member's diagnosis to her employer for employment purposes, so this answer is inaccurate and adds to her fear.
Case 3 · Question 10 of 10 · Treatment Planning · 15%

How should you respond to her request to meet every other week?

  1. Ending treatment now, because her score is in the mild range, gives up a planned way to protect her gains.
  2. Waiting for a score of zero sets an unrealistic goal that is not in her plan.
  3. A planned step-down keeps her gains, sets out what to do if worry returns, and fits her progress.
  4. A referral breaks continuity with no clinical reason.
Case 4Intake · questions 47–55Part 1 of 3

Intake

Age: 9 · Gender: Male · Sexuality: Not assessed (child)
Ethnicity: Biracial (Black and white) · Relationship status: Child; mother and stepfather married 1 year
Setting: Outpatient group practice · Counseling: Family
Provisional diagnosis: Attention-deficit/hyperactivity disorder, combined presentation, moderate: F90.2; parent–child relational problem (parent–stepchild): Z62.823

You are a licensed mental health counselor in an outpatient group practice. Alyssa, 34, and her husband Greg, 38, bring her son Mason, 9, a third grader. They married a year ago. Mason's father, who is Black, sees him every other weekend.

His teacher reports that Mason leaves his seat, blurts out answers, interrupts, loses his homework and rarely finishes his work. Alyssa says it has been this way "since kindergarten." At home he forgets chores, cannot sit through dinner and interrupts constantly. Greg says, "He just doesn't respect me," and takes away Mason's tablet for a week at a time. Homework turns into a nightly shouting match. Mason's father says Mason "is fine at my house."

Vanderbilt rating scales from his mother and his teacher both show 7 of 9 inattention items and 6 of 9 hyperactivity-impulsivity items. His pediatrician found normal vision and hearing and suggested the referral.

Mason is restless, gets up to explore the toys and makes good eye contact. His mood is "fine," and his affect is bright. His speech is rapid. He denies thoughts of hurting himself. "Greg is always mad at me," he says.

At intake, Alyssa and Greg signed your practice's no-secrets policy for family counseling.

Case 4 · Question 1 of 9 · Intake, Assessment, and Diagnosis · 25%

Which information best supports the diagnosis of ADHD, combined presentation?

  1. Six or more inattentive and six or more hyperactive-impulsive symptoms, in two settings, beginning before age 12, meet the criteria for the combined presentation.
  2. Ignoring his stepfather's requests can reflect the relationship as much as ADHD, so it does not establish the diagnosis.
  3. Normal vision and hearing rule out other causes, but they are not evidence for ADHD.
  4. Restlessness in one session is a single observation; the diagnosis rests on the history across settings.
Case 4 · Question 2 of 9 · Intake, Assessment, and Diagnosis · 25%

How should you treat his father's report that Mason "is fine" at his house?

  1. ADHD requires symptoms in two or more settings, not in every setting, so one calm home does not rule it out.
  2. Blaming the stepfather ignores that school reports the same symptoms and that they began before the marriage.
  3. Discounting the father loses useful information; a structured weekend can genuinely look different.
  4. A rating scale from his father adds an informant from another setting; reports that differ are assessed, not dismissed.
Case 4 · Question 3 of 9 · Treatment Planning · 15%

Which plan best matches current evidence for a 9-year-old with ADHD?

  1. Waiting 6 months delays a combined plan that is recommended from the start for this age.
  2. Full neuropsychological testing is not required before starting treatment for a clear ADHD picture.
  3. An elimination diet is not a first-line ADHD treatment.
  4. For school-age children, behavioral parent training together with a medication evaluation by the pediatrician is the recommended first-line plan.

Part 1 of 3 · 0 of 3 answered

Part two · First session, 2 weeks after the intake

In a family session, Greg raises his voice when Mason interrupts. Alyssa admits she gave Mason his tablet back after two days "because I felt bad." Homework still takes 2 hours a night. After the session, Greg asks to speak with you alone and says, "I'm thinking about leaving if this doesn't get better. Don't tell Alyssa."

Case 4 · Question 4 of 9 · Counseling Skills and Interventions · 30%

Which change to discipline would you coach the parents to make?

  1. Brief, immediate consequences and specific praise work for a child with ADHD because the response stays tied to the behavior; this is the core of what parents are coached to do.
  2. Longer losses lose their link to the behavior and leave the parents with nothing to work with.
  3. Separate rules make consequences inconsistent, which weakens behavior change.
  4. Planned ignoring works for minor attention-seeking behavior, not for every kind of misbehavior.
Case 4 · Question 5 of 9 · Counseling Skills and Interventions · 30%

How should you address the disagreement between Alyssa and Greg over discipline?

  1. A stepparent taking over discipline early tends to increase conflict before a relationship exists.
  2. In a new stepfamily the biological parent leading discipline, while the stepparent builds the relationship, reduces conflict and power struggles.
  3. Letting Mason choose places him above the parental subsystem.
  4. Backing every consequence without question skips the shared rules the couple needs to agree on.
Case 4 · Question 6 of 9 · Professional Practice and Ethics · 15%

How should you respond to Greg's request?

  1. Keeping the secret would ally you with one partner against the family's agreed policy.
  2. Telling Alyssa yourself takes the disclosure out of his hands and damages trust.
  3. The no-secrets policy agreed at the start of family work means you do not hold the secret, and you help him find a way to bring it to the couple.
  4. Switching to individual sessions with Greg abandons the family as the client.

Part three · Fifth session, 10 weeks after the intake

His teacher reports better seatwork, and homework now takes about 45 minutes. Mason says he likes his "special time" shooting baskets with Greg. Alyssa reports that last week, after losing a video game, Mason shouted, "I wish I was dead." "It was just a tantrum," she says. Greg adds that kids at school tease Mason about his hair, and that "we don't really talk about race at home."

Case 4 · Question 7 of 9 · Intake, Assessment, and Diagnosis · 25%

What is the most appropriate response to Mason's statement, "I wish I was dead"?

  1. Avoiding the question rests on a myth; direct questions do not increase risk.
  2. Treating it as a tantrum assumes the answer without asking; children can have real suicidal thoughts.
  3. Asking Mason directly about thoughts of dying, in words he can understand, is how risk is assessed in children; asking does not plant the idea.
  4. An emergency admission comes before any assessment of intent or plan and is not the least restrictive step.
Case 4 · Question 8 of 9 · Counseling Skills and Interventions · 30%

Your assessment finds no intent or plan; the statement came during a meltdown. Which intervention fits next?

  1. Ignoring statements about death misses future risk and tells Mason his feelings do not matter.
  2. A calm-down routine that his parents prompt before frustration peaks gives Mason a skill for the moments that lead to outbursts.
  3. Banning games removes practice in coping with losing rather than building the skill.
  4. A no-harm contract is not evidence-based and does not teach coping.
Case 4 · Question 9 of 9 · Core Counseling Attributes · 15%

How should you respond to Greg's comments about the teasing and race?

  1. A color-blind approach leaves Mason alone with experiences his family does not name.
  2. Keeping the focus on ADHD ignores teasing that affects his mood and behavior.
  3. Handing race to his father alone takes the topic out of the home where Mason lives most of the week.
  4. Inviting the conversation about race shows multicultural sensitivity and gives Mason room to talk about the teasing.

Answer every question to see your score

How close this is to the exam

The same: four options with one key, the diagnosis given in the header, cases told in three parts, questions tagged to the five scored domains.

Different:

  • Our cases carry nine or ten questions; exam cases run up to 15.
  • On the exam every question belongs to a case. Our single items train one skill at a time and are not a format you will see.
  • The exam hides an unscored case among the scored ones; here everything counts toward your result.
  • The exam gives no explanations. Ours are the point of practicing.

NBCC's own sample is one case in Appendix B of the state-licensure handbook, published without an answer key. The NBCC Foundation also sells a $34.95 study guide.

Practice built for the retired format

Some prep products still drill information-gathering sections and penalty points. Since 2022 there are no simulations, no information-gathering sections and no negative marking; the provisional diagnosis is given in the case. A practice set that asks you to pick several options at once dates from before the redesign.

After you finish

Group what you missed by the domain printed above each question, then start with the domain where you lost most:

Each page has its own cases and single items. The study guide turns the domain weights into a plan.

Questions people ask

What result here means I am ready?

None converts to an exam score: the cut is set for each form, and our cases are not equated to NBCC's. Use the explanations instead. When you can explain what rules out each distractor, the case is yours.

Why are some questions not part of a case?

They isolate one skill, such as reading a screening score or wording a reflection, so you can drill it quickly. The exam itself puts every question inside a case.

Is there a penalty for a wrong answer?

Not on the current exam and not here. A blank and a wrong answer score the same, so answer everything.