NCMHCE Exam Questions & Answers 2026 (21–30)

Question 1

Initial Intake:

Age: 31

Sex: Female

Gender: Female

Sexuality: Heterosexual

Ethnicity: Caucasian

Relationship Status: Widowed

Counseling Setting: Private Practice

Type of Counseling: Individual

Presenting Problem:

You are a counselor in a private practice setting. Your client is a 31 year-old female who reports that she is very impatient and feels angry all the time, and is taking it out on her children and others with angry outbursts. She says that her children are good but they don’t pick up when she tells them to and often, they put their toys away in the wrong places. The client states that her husband died while the family was on a vacation. She tells you that they had stopped for a break and her husband was hit by a car. She says that it happened in front of her and the children, who are now 6 and 7 years old. She endorses feeling angry, restless, and having trouble making decisions. She tells you that she is having trouble falling asleep, is anxious and overwhelmed. The client tells you that her husband was a good man and “very much my opposite.” She has high expectations for neatness and being on time, he was often messy and ran late. She tells you that sometimes she felt like the whole activity they were doing was “ruined” because he made them late or the kids didn’t follow the rules. She states that she was the “controller” in their relationship, which worked well for both of them, except when she got angry with him for not doing what she wanted, when she wanted, or how she wanted it. She acknowledges that she was often angry and frustrated with his casual way of going through life but now regrets it because he’s gone. She states that her goals for counseling are to be more patient and decrease her anger.

Mental Status Exam:

The client appears her stated age, dressed appropriately for the circumstances. Her mood is identified as sad and frustrated and her affect is restricted and flat. Her primary emotion in the session is anger, though it is expressed in a tempered manner. She demonstrates limited insight, and appropriate judgment, memory, and orientation. She reports having considered suicide when she was in high school but made no attempt and would now never consider harming herself or anyone else.

Family History:

The client reports a significant family history with her mother diagnosed with schizophrenia, with catatonia and was not medicated. She describes her mother as a “zombie” who loved her children but never told them because she was “absent.” The client describes her father as verbally abusive and involved with drugs and alcohol, often yelling, screaming, and throwing things. She states he often told the client that any mistakes she made were the reason that their life was so bad. She has no siblings but her husband has two sisters, with whom the client does not engage. She states one of his sisters is living with her boyfriend and the other asked to borrow money from her and her husband, which made the client angry. She identifies her support system as her church and a group of couples whom she and her husband were friends with prior to his death, most of whom attended the client and her husband’s high school and college. The client says she tends to be drawn to overly controlling people and her church, though fundamentalist and legalistic, became like family to her in high school. She tells you that the couple’s closest friends are her husband’s best friend, whom the client dated in high school, and his wife. She says that while dating, her then boyfriend was very attentive, “almost smothering,” but also very demanding by leaving her notes with things or work he wanted her to do for him. She states they dated for several years and then she met and married his best friend, who was her husband. She tells you that their best friend’s wife is her best friend, although “she irritates me all the time, and I don’t really like her that much.” She says her friend has a strong personality, is controlling, and wants to make all the decisions and plans in their relationship.

Using the provided information, which of the following will best help you to understand the client's relationships with others?

TheoryPractice · Accepted Answer

Family Genogram. Completing and evaluating a family genogram will help identify unhealthy patterns and interactional dynamics.

These patterns may have served the client well in childhood but have become problematic in her adult life.

The MMPI-2 is used to assess personality traits and psychopathology.

This may help the counselor determine a client's psychological state or a diagnosis, but it will not help explain the client's relationships with others.

The BAI-II measures the client's current level of anxiety at a particular moment when the test is given.

It is helpful as a pre- and post-test for monitoring anxiety levels, but will not add to the counselor's understanding of the client's relationship patterns with others.

The TAT is a projective test that helps the counselor learn more about a client's emotional conflicts, themes within the client's life experience, psychological conditions, and may help the client to express their feelings in an indirect way.

It does not provide specific information on the client's relationships with others.

Question 2

Albert Bandura’s social cognitive theory emphasizes the importance of observational learning. This means learning through observation of others’ behavior (modeling). Common models of behavior are ________ . Choose all that apply.

TheoryPractice · Accepted Answer

All of the above. Humans learn through observing others. This is especially true in children. Bandura’s concept of observational learning posits that individuals understand information, and behavior through the modeling of others, such as siblings, parents, and teachers.

Question 3

Initial Intake:

Age: 18

Sex: Female

Gender: Female

Sexuality: Heterosexual

Ethnicity: Caucasian

Relationship Status: Single

Counseling Setting: Community Residence

Type of Counseling: Individual

Presenting Problem:

Nadia is an 18-year-old in a community residence for children in foster care. She was referred for counseling because she has been running away from the group home, often for days at a time. Currently she is not getting along with her peers and gets into fights when they make comments about her activities, which is starting to affect everyone in the house.

Mental Status:

Nadia was initially resistant to the interview. She stated that she had been seeing counselors her whole life and none of them ever helped. Nadia had limited insight regarding her risk-taking behaviors. The counselor assessed that Nadia’s cognitive functioning appeared low. She stated that although she had contemplated suicide in the past, she currently had no intention or plan.

History:

Nadia is one of 10 children by her birth parents. She has an extensive history of abuse and sexual exploitation by her parents until the age of 14 when she was removed from her parent’s care. Her and her siblings were sent to various foster homes as they could not all stay together. This is a subject that Nadia does not like to talk about since she was the oldest and had the responsibility to care for the younger ones. She feels as if she let them down. Nadia is frequently truant from school. For the past 4 years Nadia was in and out of foster homes due to her risk-taking behaviors and disrespect for others. She does have a good relationship with two staff members in the group home.

Session Two

The counselor conducted a comprehensive assessment with Nadia. Results of the assessment showed an IQ score of 73, low adaptive score functioning, as well episodes of depression and mania. When the counselor reviewed this data with Nadia, she stated that she was relieved that there were reasons behind her behavior and her fluctuations in mood. Nadia shared that she sometimes felt out of control. Nadia further stated that she was concerned that she will not be able to have a normal, healthy relationship and does want to have friends.

Nadia is showing symptoms of:

TheoryPractice · Accepted Answer

Bipolar disorder and intellectual disability. Nadia is showing symptoms of bipolar disorder by risk taking behaviors as well as manic and depressive episodes. She is also showing intellectual development disorder with an IQ less than 70 to 75. Disruptive Mood Dysregulation disorder is ruled out as irritability is not the prominent feature. Although intellectual disability is common among individuals with autism spectrum disorder, Nadia is not showing apparent discrepancy between level of social-communicative skills and other intellectual skills.

Question 4

Initial Intake:

Age: 35

Gender: Male

Sexual Orientation: Heterosexual

Ethnicity: African American

Relationship Status: Divorced

Counseling Setting: Community Mental Health Center

Type of Counseling: Individual

Presenting Problem: Court-mandated counseling for violating probation and continued legal issues

Diagnosis: Adjustment disorder with mixed disturbance of emotions and conduct (F43.25) Provisional, Problems related to other legal circumstances (Z65.3)

Presenting Problem:

Davone is referred to you by his probation officer after being mandated by the court to undergo weekly emotional and behavioral health counseling sessions for a minimum of 9 months or until his next court hearing is scheduled, whichever is sooner. Davone’s Medicaid insurance cover his sessions. The probation officer tells you Davone is undergoing sentencing for violating his probation and restraining orders put in place by his ex-wife, which render him unable to set foot on their property or visit with his children (twin boys, age 9, and girl, age 4). In the initial assessment, Davone shares that he has had run-ins with the criminal justice system for most of his life “just like his father” and that he fears a lifetime of being in prison and not being able to be there to watch his kids grow up. Davone tells you he will do anything to get out of his situation and return to having a life where he can continue going to work and providing for his children.

Mental Status Exam:

Davone presents as well-groomed, of fair hygiene and motor movements are within normal limits. Davone makes decent eye contact throughout session. Speech tone and rate are normal. Thought process unremarkable. Denies SI/HI. Davone becomes tearful when he recalls past family information, sharing that his father was never around for him for the same reasons he is not around for his family. Davone frequently refers to his racial background and where he grew up, becomes angry as evidenced by tense expression, furrowed brow, and clenched fists, and then self-soothes without prompting by taking a deep breath and moving forward in conversation. When asked, Davone tells you he learned those skills in past anger management classes he was mandated to take years ago.

Legal and Work History:

You learn from Davone’s referral paperwork that Davone’s legal record extends back to age 9 when he was first beginning to show signs of conduct at school. Davone was often sent to the “recovery room” in elementary school for aggressive outbursts and defiance towards teachers. He has a record with the Juvenile Justice System for breaking rules and truancy in middle and high school. After age 18, he was arrested several times for misdemeanors of vandalism, shoplifting and reckless driving. He then married and became employed full-time by age 25, where he did not get into trouble with the law again until age 31 when he got fired for stealing from his company. This caused marital discord and led to Davone’s divorce two years ago. Davone has had a continued string of misbehavior, arrests, and short-term jail stays ever since. Davone adds that his ex-wife accused him of consistently endangering her and the kids without caring, which is why she got the restraining order. He disagrees with her, saying “I would never harm my kids.”

First session, one week after the intake session

You meet with Davone in your office for your second session. As you review his completed treatment plan and are reading for him the goals and objectives you have decided on with him in the last session, you notice he is darting his eyes, shifting his position often, and presenting as either agitated or disinterested. When you ask what is on his mind, he says “I’ve done all of this before, it doesn’t help because I keep getting locked up. I just want to see my kids! I don’t understand why Gina won’t let me.” After using several different interventions throughout the session, you realize that Davone repeats himself often, rejects feedback given, and defends his choices using emotional reasoning. He remains respectful in attempting to engage as requested but needs continual prompting to respond and frequently talks in circles around the same arguments.

You respond to Davone saying “You are clearly disappointed, and obviously hurt as well! I can’t imagine not being able to see my children. It would be so hard.” This is an example of:

TheoryPractice · Accepted Answer

empathy. Validating your client’s presentation and feelings while attuning to their emotional condition can strengthen your therapeutic bond and help them to feel heard and understood.

Offering sympathy shows pity for your client but does not accomplish the congruence that empathy does and maintains an emotional distance from your client, placing them in a position to feel the same sorrow and pity for themselves as opposed to connected.

Reflection is part of the active listening process in which the therapist repeats back to the client what was heard.

Direct correlation is a mathematical term.

Question 5

Initial Intake:

Age: 40

Sex: Female

Gender: Female

Sexuality: Lesbian

Ethnicity: African American

Relationship Status: Partnered

Counseling Setting: Community Agency

Type of Counseling: Individual

Presenting Problem:

You are a counselor in a community agency. Your client presents with concerns about her lifelong history of being “anxious and emotional” since her parent’s divorce when she was 12. She tells you her feelings of “anxiety and feeling badly about myself” intensified when she was diagnosed with breast cancer four years ago and then again when her family moved to the area last year. She tells you that she thinks she managed her emotions well during her treatment because her focus was on getting through the crisis. She also was taking Klonopin twice a day for anxiety. She says she feels that she has let her family down by having cancer because it costs them monetarily and emotionally; she wonders sometimes if her cancer is a punishment for something she’s done. She reports that she does not discuss these concerns and emotional fears with her partner because “she has become the breadwinner and I feel like I need to protect her from my negativity.” On intake forms, she endorses crying daily, trouble sleeping, concentrating on things, has been losing weight without trying, and constantly worrying about her health and the family’s finances. She tells you that her partner says she “runs around like a chicken with my head cut off because I start stuff like cleaning or cooking and then stop right in the middle of it. I just get restless and sometimes I just can’t stop fidgeting when I should be paying attention.” She notes that she is in menopause due to her cancer treatments, which included a removal of her ovaries three years ago and a hysterectomy one year ago. She tells you people often refer to her as a “cancer survivor” but she doesn’t feel like she has survived it because every surgery makes her feel like she “is losing another piece of me.” Additionally, she says that having to have body scans every six months and not being able to look in the mirror and see a “complete woman” makes her feel that she is still trying to survive, rather than putting it in the past.

Mental Status Exam:

The client appears to be slightly older than stated and demonstrates positive signs of self-care in her hygiene and dress. She states her mood fluctuates between “sad and okay.” Her affect is labile and mirrors topics discussed in session. She smiles when describing her children and her relationship with her former oncology team. She cries easily when discussing cancer, moving, instability, and fears. The client is cooperative and forthcoming, with easily understood speech. She offers insight into her thoughts and behaviors, is attentive, and shows no difficulties with memory or judgement. She acknowledges one episode of suicidal ideation, without plan, during her adolescence when she desperately missed her mother while on a custodial visit with her father. She has had no thoughts of harming herself since then and has no thoughts of harming others.

Family History:

Your client reports a four-year history of treatment for breast cancer. She has had 16 months of chemotherapy and 27 rounds of radiation, as well as a double mastectomy three years ago. She has completed reconstructive surgery for her breasts but has not yet added nipple tattooing for a more realistic image. She reports that she has three close female relatives with breast cancer, but no relapses after treatment. She states that she has been in a relationship with her partner for 17 years and they share two children, ages 12 and 8. She describes her partner as a “good person” and the relationship as “good.” She tells you that they moved to the area one year ago when her partner had an unexpected promotion. She reports this has been good but that their oldest child is “anxious, emotional, and just angry sometimes.”

First Session, three weeks after the intake session

The client presents with her partner for this session. She tells you that she spoke with her doctor who prescribed an SSRI and she is feeling somewhat better emotionally, but still feels upset. She says that is why she invited her partner to join her today, because she hopes that the three of you can figure out why she still feels bad. During the session, the client mentions that “you didn’t go with me” when talking to her partner about her early oncology appointments. You notice that her tone changes and she looks away from her partner as she says this. As the session continues, the client reports that her partner didn’t seem “interested” because she never read the pamphlets that the client left on the counter, never researched for cures or therapies, or came with her to chemotherapy appointments, even though the client acknowledges that she always told her partner she could go alone so her partner could work. At one point in the discussion, she talks about the loss of their sexual and intimate relationship. She uses a fast hand motion to wipe each tear quickly away as soon as it forms, never looking at her partner and only making eye contact with you.

Based on the information provided, your client is most clearly demonstrating which of the following?

TheoryPractice · Accepted Answer

Anger at her partner for not reading her mind. The client's change in tone and eye contact away from her partner, as well as blaming her partner for her lack of involvement and participation in her cancer treatment, strongly suggests that the client believes her partner should have known what the client needed, without being told.

This passive-aggressive style of communication often leads to angry emotions.

The client's eye contact with the counselor and hurriedly wiping away tears also suggests angry emotions about the loss of intimacy, though this is likely to be connected to her partner not meeting the client's unexpressed needs.

The client's communication style appears to be holding in her emotions and then allowing them to come out in anger.

This is not an effective style of communicating with others.

The client may be using her independence, strength, and control as coping strategies, but they isolate her from her partner more than unite her, thus they are not positive in these circumstances.

Question 6

A major critique of structuralism was that the theory dealt predominantly with ________ concepts.

TheoryPractice · Accepted Answer

Unobservable. Behaviorist’s originally criticized structuralism for its’ focus on indistinguishable, unobservable generalizations. While structuralism allowed for descriptions of conscious experiences, these were thought to be ambiguous, hypothetical interpretations.

Question 7

Who is a well-known therapist who brought spiritual topics into the psychology field in the early 1900s?

TheoryPractice · Accepted Answer

Carl Jung. Carl Jung was responsible for bringing spiritual discussions to therapy sessions in the early 1900's.

Question 8

What are the benefits of a peer-to-peer support group?

TheoryPractice · Accepted Answer

All of the above. Peer-to-peer support groups are sometimes referred to as self-help groups; participants are all usually dealing with the same struggle or issue, therefore the group itself becomes a safe place where participants can feel open; peer-to-peer support groups also tend to encourage and empower participants as they view others making progress; these groups are inexpensive to run, as there are not many costs involved, and often the space needed to hold the group is donated.

Question 9

Initial Intake:

Age: 35

Sex: Male

Gender: Male

Sexuality: Gay

Ethnicity: African American

Relationship Status: Married

Counseling Setting: Private Practice

Type of Counseling: Individual

Presenting Problem:

You are a counselor in a private practice setting. During the intake session, you learn that your client and his spouse have been married for 7 years and together for 10 years. He states they have 2 children and he is their primary caregiver from early afternoon until evenings; this includes transportation, preparing dinner and homework. He states his spouse and he moved their family here earlier this year to be closer to his husband’s family. He works as a high school teacher. He presents relationship issues as his main concern and rates these as “very difficult,” and has been told that he and his husband “may be heading for divorce.” He states he often feels “suspicious” because his husband has multiple friendships with other males, online and face-to-face, including old boyfriends. The client tells you he feels this is inappropriate but that his husband disagrees and will not end these friendships. He admits being stressed, overwhelmed, sad, having little energy, and experiencing crying spells, irritability, and angry outbursts. He says he feels like a failure. He says his husband said he has not been “emotionally available” since their marriage. The client notes that during the year they married, he finished his teaching credentials, the couple adopted their first child, and he began working as a first year teacher in a high school with tenure requirements.

Mental Status Exam:

The client presents appropriately dressed and is well-groomed. His stated mood is congruent with stated affect but you note a limited range of emotions. He appears to be cooperative and forthcoming. He endorses no use of illegal or inappropriately prescribed drugs and a 20-year history of alcohol abuse, with one driving citation at age 21. He currently drinks 3 to 4 beers per day and 16 or more on the weekend. He acknowledges using alcohol to relieve emotional discomfort and feels the need to cut down. He is able to offer insight into his thoughts and behaviors, and demonstrates appropriate memory and judgement.

Family History:

The client states he has three siblings. He relates he has a “pretty good” relationship to his brother, a moderate connection to his younger sister, and a tenuous connection to his older sister. He says he has cut himself off “emotionally and physically” from his own parents and his husband’s family due to “conflicts.” He describes his mother as manipulative and attributes the lack of many extended family relationships to her. He describes the relationship between his parents as conflictual but that his father “goes along with her” and has cut off relationship with the client’s older sister, his father’s twin sister and her spouse. The client says his mother has never liked the client’s spouse. He said she was not happy he married a man, but was even more upset that his husband is White. During one family visit, his mother left a derogatory email about his husband in a visible place so he would find it.

Second Session, six weeks after the intake session

The client arrives for the session appearing tense and in some distress. As the session progresses, the client admits that the issues between him and his husband have worsened, particularly as the client is spending more energy working on his own issues. He tells you that he has been attending Alcoholics Anonymous several times a week and is working with his sponsor. He also states that he has been eating lunch with the other teachers at school and has begun developing some friendships where he can share his stresses related to work requirements because these are common irritations for all of them. This has made him feel happier, less tense when he comes home, and does not feel like he needs to rely solely on his husband to be able to work through his stressors. However, he reports that his husband seems angry because the client has refused to drink with him in the evening and keeps making negative remarks about the client’s sponsor. The client says that his husband has berated him several times for meeting with his sponsor several evenings a week, and leaving his husband responsible for caring for their children in the evenings. Your client tells you he is “beginning to see an ugly side” of his spouse and wonders why his husband isn’t happier for him that he is taking better care of himself.

Which of the following interventions should be implemented during this session?

TheoryPractice · Accepted Answer

Provide psychoeducation on systems and the impact of change. Individuals exist in systems, and systems theory states that when one member of the system changes, this causes distress for the other members of the system as they respond to the change.

The client's changes are helpful for him but create dissonance for his husband when the client is not responding as he usually does.

Providing education on change and its impact on the family system allows the client to understand current circumstances and may help him respond with empathy to his partner as they navigate the changes.

It would be inappropriate for the counselor to suggest the client might not want to stay in the relationship or suggest that the client should either strengthen or lower his boundaries to appease his spouse.

Question 10

Initial Intake:

Age: 26

Sex: Male

Gender: Male

Sexuality: Heterosexual

Ethnicity: Caucasian

Relationship Status: Single

Counseling Setting: Private Practice

Type of Counseling: Individual

Presenting Problem:

You are a counselor in a private practice setting. 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.”

Mental Status Exam:

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. 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.

Family History:

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.” 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.

First Session, three weeks after the intake session

The client presents for his session having completed assessments that show he does not experience dissociation at a level above normal. He tells you that he knows he needs to work through the trauma that he experienced after his father’s death, but that he is very anxious about having to talk about that night or how much he misses him. He says that even talking about it makes him very upset and he begins to get angry. He tells you that he can deal with feeling angry inside, but when people keep asking him “what’s wrong with you,” he gets even angrier and sometimes yells at them or walks away. He also tells you that he is afraid to remember that night because the pain is so hard that he feels like “it will swallow me up.”

Which of the following interventions would be the least effective in helping the client manage the intense emotions that emerge in trauma treatment?

TheoryPractice · Accepted Answer

Scheduling shorter sessions to reduce the amount of time the client spends with emotions. Working with traumatic content often requires a full session or sometimes a 90-minute session so that the counselor and client will have time to work through traumatic material and then help the client regain emotional equilibrium prior to leaving the session.

Shorter sessions would not allow the client and counselor to work with disturbing emotional content and still have time to help the client recover from these before the session is over.

Container exercises are helpful techniques that allow the client to place their intense emotions in a real or imagined container that will hold these until the next session.

Having the client select a word or hand motion that signals the counselor that they need a break because of intense emotions allows the counselor to help the client ground themselves and take time to recover before proceeding again.

Teaching and practicing breathing exercises are helpful tools for clients to use when they are overwhelmed with intense emotions.

Concentrating on their breathing and relaxing each part of their body distracts the mind from the emotions and allows the client to feel more in control.

NCMHCE Exam Questions & Answers 2026 (21–30)

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