NCMHCE Exam Questions & Answers 2026 (11–20)

Q11Initial Intake:<br/><br/>Age: 82<br/><br/>Sex: Male<br/><br/>Gender: Male<br/><br/>Sexuality: Heterosexual<br/><br/>Ethnicity: Caucasian<br/><br/>Relationship Status: Widowed<br/><br/>Counseling Setting: Community Clinic<br/><br/>Type of Counseling: Individual<br/><br/>Presenting Problem:<br/><br/>Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.<br/><br/>Mental Status:<br/><br/>Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.<br/><br/>History:<br/><br/>Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.<br/><br/>Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.&nbsp;<br/><br/><u>Session One</u><br/><br/>Theodore came to the next session on his own. He stated that the only reason Nate drove him for the intake was because Nate was always trying to control everything. When asked how he was doing, Theodore stated that he attended the bereavement group the week before. It was good for him to go as he felt validated and heard. Theodore stated that he felt it was good for him to see others in different stages of grief and to be around others who can relate to losing a spouse. Theodore then spoke to the counselor about not wanting to live with his son and that he wanted to be able to live on his own, even if it is at an assisted living place. Theodore stated he believed Nate was worried that he would lose Theodore just like he lost his mother. Theodore further stated that he is at the stage of his life where he is accepting of death and believes he has led a meaningful life. When asked about his rapid weight loss, Theodore stated that he and his wife used to make dinner together every night. After her death, it pains him to cook in the kitchen where so many memories come back to him.<br/><br/>An immediate objective for Theodore should be:

• Ato find another way to make meals for himself
• Bto find housing
• Cto determine his own goals
• Dto tell his son he doesn't want to live with him

Q12A goal of existential therapy is for clients to face their fears. A common fear clients’ present is the fear of death. To address this fear, clinicians frequently ask this question:

• AWhere do you want to be buried?
• BWhat do you wish you could change about your life?
• CWhat does your religion say about death?
• DHow would you live your life differently if you knew you would die next week?

Q13Initial Intake:<br/><br/>Age: 26<br/><br/>Sex: Male<br/><br/>Gender: Male<br/><br/>Sexuality: Heterosexual<br/><br/>Ethnicity: Caucasian<br/><br/>Relationship Status: Single<br/><br/>Counseling Setting: Private Practice<br/><br/>Type of Counseling: Individual<br/><br/>Presenting Problem:<br/><br/>You are a counselor in a private practice setting.&nbsp; Your client is a 26-year-old male who presents for counseling at the request of his family and his employer, with whom he is close and who knows his history. The client tells you that he has been angry for the past 15 years, beginning a year after the death of his father from a heart attack. He says that his anger is triggered very quickly when frustrated by people or situations and that his “fuse is very short these days.” He states that he has been in some “loud arguments” with his mother, and later his stepfather. He admits that there have been times in the past when he and his stepfather have “almost come to blows” but his mother stepped in and made them stop. He admits to having hit or kicked walls at times in his anger, but has never hit a person. He tells you that he doesn’t want to feel this way because it interferes with his relationships and his former girlfriends have never understood that when the anniversary of his dad’s death comes around, he just wants to be alone for a couple days and not have to talk to anyone. He tells you that he has never had a long-term relationship with a woman because either he gets “depressed” for a few days during certain times of the year (i.e., father’s birthdate and death date) or because he is too quick to get angry and then says things he doesn’t mean. He says that he has been in a relationship with a woman now for eight months and really wants to get himself together because he feels “she’s the one.”<br/><br/>Mental Status Exam:<br/><br/>The client appears his stated age and is dressed appropriately for the circumstances in clean jeans and a t-shirt. He identifies his mood as “anxious but a little excited” because he “is hopeful that he can finally let his anger go.” He tells you he is tired because he has difficulty falling asleep and staying asleep most nights. His affect is pleasant with emotional lability evident. He demonstrates appropriate insight and judgment, memory, and orientation.&nbsp; He reports never “seriously” having considered suicide but acknowledges that there were times when he wondered “if dying would make this pain go away.” He has never attempted suicide and states he would never consider harming himself or anyone else.<br/><br/>Family History:<br/><br/>The client reports a family history of being the youngest of three siblings born to his mother and father. He reports a “great life” with his family and that they regularly spent time together playing, camping, traveling, and “just being a family.” He tells you that he is sure there were occasional arguments but that he doesn’t remember anything significant, except that he had been mad at his dad the night he died because his dad wouldn’t let him stay up late, but that before the client went to bed, he had come down, apologized to his dad, and they had both said “I love you.”&nbsp; He states his parents had been married for 15 years prior to his father’s death, which occurred when the client was 11 years old. He states his dad died of a heart attack while sleeping, so while he did not see it, he knew something had happened because his mother woke him and his siblings and rushed them over to the next door neighbors’ house. He said that his mother went to the hospital with his father in the ambulance and came home that night to tell him and his siblings that their father had died. He tells you that he and his siblings are still very close and that they now have three much younger siblings born after his mother married his stepfather. He says that he is very close to his mother and stepfather, although he lives three hours away from them. He tells you that he tries to get home for big family events, like birthdays. He states that his stepfather adopted him and his siblings after the wedding and the client loves him very much. He tells you that he and his stepfather have gotten in what the client thinks are “typical teenager/parent” conflicts but that they have often been made worse by the client’s anger that seems to always be inside and erupts quickly.<br/><br/>Which of the following treatments would be least helpful for treating this client?

• ABrain Spotting
• BProlonged Exposure Therapy (PE)
• CTrauma-focused Cognitive Behavioral Therapy (TF-CBT)
• DEye Movement Desensitization Reprocessing (EMDR)

Q14Initial Intake:<br/><br/>Age: 20<br/><br/>Gender: Male<br/><br/>Sexual Orientation: Homosexual<br/><br/>Race/Ethnicity: African American<br/><br/>Relationship Status: Single<br/><br/>Counseling Setting: University counseling center<br/><br/>Type of Counseling: Individual<br/><br/>Presenting Problem: Stress, anxiety, depression<br/><br/>Diagnosis: Anxiety disorder, unspecified (F41.9), Major depressive disorder, single episode, unspecified (F32.9)<br/><br/>Presenting Problem:<br/><br/>You are a brand-new counseling intern in the counseling resource center of a local university. Jonathan is a junior in college and comes to speak with you, as you are his newly assigned college university counselor. Jonathan is concerned about finals that he feels unprepared for, stating he is “overwhelmed” and “under too much pressure” from his family to “allow himself” to fail. He is making disparaging, negative remarks about himself and his abilities, often repeating himself and talking in circles using emotional reasoning. He asks you for help in getting his teachers to modify his deadlines so that he can have enough time to accomplish all his assignments, mentioning that his last counselor did that and called it “playing the mental health card”. There are no previous records on file for this student, but when you ask him who he met with he just changes the subject and continues to express his worry that he will “never amount to anything or graduate” if he fails these exams.<br/><br/>Mental Status Exam:<br/><br/>Jonathan presents as anxious with congruent affect, evidenced by client self-report and therapist observations of fidgeting, inability to sit still, tearfulness and shallow breathing with rapid paced speech. Jonathan occasionally closes his eyes and takes deep breaths when he begins to cry in attempt to slow himself down and prevent what he calls “another emotional breakdown.” He has prior inpatient treatment history of a one-week episode where he was involuntarily committed at 17 for making comments about planning to kill himself in response to his stress over finishing high school. He admits to passive suicidal ideations in the past few weeks while studying for exams but does not report considering a method or plan. He reports that he has been losing sleep because of long study hours and feeling too keyed up to calm down. You assess him as having distress primarily associated with anxiety, which at times of abundant stress turns to episodes of depression and hopelessness.<br/><br/>Education and Work History:<br/><br/>Jonathan has a high academic performance history, despite short periods of time where he experiences heightened stress. Jonathan has never gotten in trouble in school or had any infractions at part-time jobs later as a teenager. He has worked after-school jobs at the grocery store, bowling alley, and local town library. Jonathan had only one work-related incident where he broke down emotionally when feeling overwhelmed and left work in the middle of his shift, but his supervisor was supportive and helped him.<br/><br/>Current Living Situation:<br/><br/>Jonathan lives in the college dormitory with a peer and is supported by his mother. His mother is a single mom who works full-time in Jonathan’s hometown, which is almost a full day’s worth of driving from where Jonathan goes to college. Jonathan mentions that his friends call him “Jonny.” He adds that the food available to him is not very healthy and he has poor eating habits due to prioritizing studying and his involvement in extra-curricular activities.<br/><br/>How should you format a goal for suicidal ideation?

• Adescribe levels of SI as more or less severe
• Bensure the goal aims to eliminate SI
• Cproject seeing reduction in six months
• Dconduct updated assessments monthly

Q15Initial Intake:<br/><br/>Age: 53<br/><br/>Sex: Male<br/><br/>Gender: Male<br/><br/>Sexuality: Heterosexual<br/><br/>Ethnicity: Caucasian<br/><br/>Relationship Status: Married<br/><br/>Counseling Setting: Community Agency<br/><br/>Type of Counseling: Individual<br/><br/>Presenting Problem:<br/><br/>You are a counselor in a community agency setting.&nbsp; Your client is a 53 year-old male who presents with complaints of feeling insignificant, unworthy, and a failure. He admits to having these feelings for the past 30 years and while he has never had suicidal ideations or plans, he has often wondered if his life had purpose and what that purpose was. Your client additionally tells you that he doesn’t feel happy on most days though he does have happy feelings at times; they just don’t last. He is good at his job and finds it challenging, yet tells you “it’s a job” and that there is nothing special or “exciting” about it to him. He tells you that he has been married for twenty years and has five children; three of whom he adopted when he married his wife. He states he adores his wife and children, though he knows that he often does not meet their needs emotionally, “tunes out,” and frequently puts his own “wants and desires” before their requests, needs, or previously made plans. He admits he gets “jealous, I guess” when someone else in the family gets something that he didn’t. He also says that he often says “the wrong thing” when his wife or children are upset about something and he struggles to understand how they are feeling. He tells you that these actions cause conflict in his marriage and with his children and he is ashamed that he does this, but feels hopeless that things will change because he cannot figure out how to change or why he does these things. He reports that he does not believe himself to be better than others but that others often perceive that he sees himself that way because of how he interacts with them. He also tells you that his family often wishes he would “think before I speak or make decisions.” He reports that in spite of these “failures,” he and his wife have a very strong marriage and express their love for each other daily. They enjoy activities together although he needs very active recreation such as roller coasters, bike riding, and swimming while his wife leans towards less physical activities. Finally, your client tells you that over the years he has had some trouble focusing at work and at home. He views himself as “forgetful” and says “I don’t have a good memory.” He says this causes troubles at home and work when he frequently forgets to do something that he said he would do or when he is not as careful or gets distracted in his work and is slow to finish projects or makes small mistakes that have greater impacts on reports.<br/><br/>Mental Status Exam:<br/><br/>The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “anxious.” His affect is congruent though he appears to relax as the session continues.&nbsp; He demonstrates some limited insight and frequently responds with “I don’t know” but when encouraged, is able to access thoughts and emotions that are disturbing to him. He demonstrates appropriate judgment, memory, and orientation. He reports never having considered suicide or harming himself or anyone else. He states that he is very engaged individually and with his family in their religious practices and views these as a source of strength. He currently takes 50 mg of Pristiq and Concerta 18 mg.<br/><br/>Family History:<br/><br/>The client reports his parents were married to each other until his father’s death at age 60. Your client states he was very close to his father although his father’s activities were often curtailed due to illness. He states that his father accompanied him to boy scouts and was involved with the client and his older siblings. The client states that he has always been close to his mother although he acknowledges often feeling angry at her but being unable to tell her that, so instead he “tuned her out.” He describes her as extremely “critical and consistent.” He tells you that the first time he decorated a Christmas tree was with his wife as his mother always decorated their family trees “so they were done right.” He also says his father and siblings could always count on her to be the one who made the family late for everything and left them waiting during outings. In one example, he shares that when going out together, his mother would often set a meeting place and time for him. He reports that he would either wait at the meeting spot for hours because she was late or that he would sometimes go looking for her and then get in trouble for leaving the meeting spot. He reports that his oldest sibling died in his 40s from excessive drug and alcohol use, and that his other sibling has a very conflictual relationship with their mother and sees their mother “when needed” but is often angry with their mother. He describes his relationship with his mother over the past twenty-five years as one in which his mother makes promises without keeping them and was often dismissive of the client’s wife and children during the time that he was dating and for several years after their marriage. He relates one account where his mother was helping his wife organize something in their home, but refused to organize it in the manner that his wife needed it, and instead became very angry, defensive, and accusatory when his wife reorganized what his mother had done.<br/><br/>Considering the information provided, which question will be most effective to ask when setting treatment goals for the client?

• AAll of the above
• BWhich is most important to work on: your depression, narcissistic traits, or ADHD?
• CWhat do you hope to gain from working together in counseling?
• DWhat have you tried in the past to make changes that haven't worked?

Q16Initial Intake:<br/><br/>Age: 45<br/><br/>Sex: Male<br/><br/>Gender: Male<br/><br/>Sexuality: Heterosexual<br/><br/>Ethnicity: Caucasian<br/><br/>Relationship Status: Married<br/><br/>Counseling Setting: Private Practice<br/><br/>Type of Counseling: Individual<br/><br/>Presenting Problem:<br/><br/>You are a counselor in a private practice setting.&nbsp; Your client is a 45-year-old male who reports that his wife of two years suggested he seek help for what she says is “OCD.” The client says that several months after their marriage, his wife began complaining that the client had so many expectations for her and her children that they are overwhelmed and feel unable to please him. The client tells you that he has had friends tell him in the past that he is “OCD” and sometimes his employees make fun of him because he wants everything done a certain way. He says that they sometimes call him “the eye” because they say he is always watching to make sure they do things correctly.&nbsp; Some of his closer friends will “test me” sometimes by moving something to see if the client notices it. He tells you they are doing it in fun, and he doesn’t really mind because he automatically notices things, whether they moved something or it has accidentally got put in the wrong place. He admits that he is concerned that things are done well because he owns his own business and needs it to be managed correctly, but he doesn’t really understand his wife and stepchildren’s concerns. He tells you that he would like to know if he “is the problem” and if so, how he can make changes to help his marriage. He tells you that he doesn’t see a problem with how he runs his business and thinks that his employees are just “complainers.”<br/><br/>Mental Status Exam:<br/><br/>The client appears his stated age and is dressed appropriately for the circumstances. He rates his mood as “happy” and this is congruent with his affect. He demonstrates some social awkwardness in presentation and conversation both in missing social cues and oversharing. He demonstrates some motor hyperactivity, indicated by fidgeting, shifting in his seat, and upon entering the office, is invited to sit as he was touching items on the bookshelf. He presents as very talkative, distractible, and tangential in his conversation. It is necessary to redirect him often as his explanations and responses include excessive and irrelevant details, and provides responses before the question is completely stated. He demonstrates limited insight into his presentation or the concerns others have shared with him. He demonstrates appropriate judgment, memory, and orientation. He reports no substance use, no sleep or waking problems, and does not smoke. He is emphatic in his negative responses to questions related to suicidal or homicidal thoughts and intentions.<br/><br/>Family History:<br/><br/>The client reports being the youngest of two sons born to his parents. His parents have been married for 40-plus years. He tells you that his mother did complete high school with some difficulty and has never been employed. His father is now retired but was an accountant previously. He says his older brother had a difficult time several years ago with holding a job and going through a divorce, but is now doing much better. The client tells you that his family is still very close, his parents come over to visit often, and prior to buying his business, he often vacationed with family. He says that while growing up, their mother has always been overprotective of him and his brother and has always made sure that they did things the right way. The client states that until his marriage, he continued to live in his parent’s home in his childhood bedroom. He says that even though he took care of his own things, his mother still checked behind him every day to make sure the bed was made correctly and that nothing needed cleaning up. The client says that his parents were constantly frustrated with his brother because he didn’t take care of his room and things. The client reports that he completed a college degree in business and chose to open his own franchise business so that he could work for himself. He has owned his business for six years and enjoys it, although he rarely has time off. He tells you that his father and mother stop by the store frequently “just to help out.” He says his mother likes to help with cleaning and his father helps with the accounting.<br/><br/><u>Second Session, six weeks after the intake session</u><br/><br/>The client arrives for his session and tells you that he had an argument with one of his stepchildren the other day and that it really disturbed him. He says that he asked his stepson to mow the lawn and to make sure that he did so horizontally across the yard since the client changes the direction each time he mows. He tells you that his stepson didn’t do as asked and ran the mower vertically across the yard so that it was in the same pattern as last week’s mowing. The client reports that he and his stepson ended up arguing about it and his stepson yelled at him, “if you can’t be satisfied with the job that I did, then do it yourself next time!” The client tells you that this made him very angry but later as he was talking with his wife, she explained that even though it wasn’t the way the client wanted it done, that her son had contributed to helping the family and doing something that the client wanted completed. The client says he struggled because he wants the grass to grow well and alternating the pattern of mowing is important, but there was a part of him that felt sad and angry at himself for getting mad at his stepson, even though the client knew his stepson was wrong for not doing what he was told.<br/><br/>Which of the following would be most appropriate for helping the client navigate his dilemma?

• AThe rules say your stepson was wrong, but a part of you seems to be questioning the rules
• BWhy do you think you feel sad and angry at yourself?
• CYour stepson didn't do it the way you wanted but you feel upset for getting angry
• DYour rules created a barrier between you and your stepson's relationship

Q17<h3><strong>Part Two</strong></h3><br/> <h4><em>Second Session, 2 Weeks After the Initial Intake</em></h4><br/> The client enters the room and appears distracted when she sits down because she has a furrowed brow and is looking off to the side of the room. You ask her what is on her mind, and she reports that this morning she had a panic attack that led to her throwing up. You ask her to talk through the moments when she noticed it starting and how the panic attack progressed. She says that she woke up and was worried that she might have a panic attack because she typically has one on school days, and this turned into worry that she might be late for class, which compounded into worry about how it might affect her grades and eventually into certainty that she would fail. The client then experienced an increased heart rate, chest tightness, difficulty breathing, a feeling of impending doom, shaking, and finally vomiting. You empathize with the client and provide psychoeducation on the management of panic attacks.<br/><br/>Which of the following would be considered a negative attending behavior?

• Aleaning forward
• Bturning your body 30 degrees in relation to the client throughout the session to present a less aggressive posture
• Cusing hand gestures for emphasis
• Dconsistently matching the client’s posture and repeating her statements throughout the session

Q18Sex indicates an individual’s biological gender, while gender refers to one’s cultural, and psychosocial concept of maleness or femaleness. Furthering the notion of gender and sex is the perception of gender identity, which refers to an individuals’ <code>________</code> as male, female, or gender neutral.

• AGenetic identity
• BInconsistency in identifying
• CBarriers to identifying
• DPsychological identity

Q19As a person of color, Oliver's client experiences discrimination and racism every day. This makes him feel depressed and anxious. <br/><br/> Which type of bias is Oliver's client experiencing?

• ABias of the counselor
• BHe is not experiencing bias.
• CBias of society
• DBias of the client

Q20Initial Intake:<br/><br/>Age: 82<br/><br/>Sex: Male<br/><br/>Gender: Male<br/><br/>Sexuality: Heterosexual<br/><br/>Ethnicity: Caucasian<br/><br/>Relationship Status: Widowed<br/><br/>Counseling Setting: Community Clinic<br/><br/>Type of Counseling: Individual<br/><br/>Presenting Problem:<br/><br/>Theodore is an 82-year-old who was referred for grief counseling by his son, Nate. Theodore’s wife, Nancy died one month ago after a 4-year battle with cancer.<br/><br/>Mental Status:<br/><br/>Theodore is tearful most days and has dropped a significant amount of weight. He has not been sleeping and stays up watching videos of his deceased wife.<br/><br/>History:<br/><br/>Theodore was the primary caretaker for Nancy and has not paid attention to his own health in years. Nate would like his father to move in with him and his family and sell the house his parents lived in to pay off their debt. However, Theodore refuses to sell the house and stated that he will not give away or sell anything that they owned. Nate drove Theodore to the initial session and sat in for the intake, with Theodore’s consent.<br/><br/>Once everyone sat down, Theodore looked at the counselor and stated, “I am only here so my son stops bugging me about selling the house. I am not getting rid of anything in that house- and especially not the house itself!” Nate explained that his father cannot maintain the house on his own and is worried about him being lonely. Theodore insists that he has other options and thinks that living with Nate would put a burden on him.&nbsp;<br/><br/>Which of the following diagnoses can be ruled out based on the symptoms Theodore is exhibiting?

• AAdjustment disorder
• BHoarding
• CPersistent Depressive Disorder (Dysthymia)
• DNormal grief reaction