NCMHCE Practice Test: Clinical Case Study Questions
The National Clinical Mental Health Counseling Examination: 11 case studies, each with an intake and two counseling sessions
11 case studies, 132 questions in 225 minutes, with sections that lock as on the real exam and a score for every domain.
Free case study drillCase study · Part 1: Intake
- Age: 40
- Gender: Female
- Ethnicity: Guatemalan
- Relationship status: Separated
- Counseling setting: Domestic violence agency
- Type of counseling: Individual
- Provisional diagnosis: Posttraumatic stress disorder
You are a counselor at a domestic violence agency. The client left her husband three months ago after years of physical and emotional abuse and is living in a shelter with her two children, ages 9 and 13. She speaks Spanish and some English, and a trained interpreter joins the session. She reports nightmares, startling at loud voices, avoiding the neighborhood where they lived and feeling “numb.” She says her husband has sent messages through relatives saying he will “find her.” She blames herself for “not leaving sooner.” She works cleaning offices at night. She denies suicidal thoughts. She says her church taught that marriage is forever, and she worries God will not forgive her. Mental status: neatly dressed, hypervigilant, anxious and sad mood, logical, no psychotic symptoms. She asks whether her immigration status will be reported.
The client asks whether her immigration status will be reported. How should the counselor respond?
The NCMHCE at a glance
The NCMHCE tests how you apply counseling knowledge to clients. Since November 2022 it has been a set of 11 written case studies. Each case opens with an intake summary (client details, presenting problem, mental status exam and history), then moves through two counseling sessions. Every section is followed by multiple-choice questions with four options about that point in the work: rapport and ethics at intake, diagnosis and risk, goals and interventions as treatment goes on. One case and some questions are unscored.
- Format
- 11 case studies, 130–150 four-option questions (100 scored) in 225 minutes
- Our practice exam
- 11 original cases, 132 questions, the same clock and sections that lock as you continue; part of the counseling exam pass
The NCMHCE format in force
- 11 case studies with 9–15 questions each, 130–150 questions in all. 100 questions are scored; one whole case and some other questions are unscored field-test items.
- 225 minutes of exam time, in a 4 hour 15 minute session that includes a 5-minute agreement, a 10-minute tutorial with a sample case, and one scheduled 15-minute break after the fifth case.
- Each case comes in three sections: the intake summary and two counseling sessions. You can review and change answers within a section; once you continue, earlier sections are closed.
- Domains: Professional Practice and Ethics 15%, Intake, Assessment, and Diagnosis 25%, Treatment Planning 15%, Counseling Skills and Interventions 30%, Core Counseling Attributes 15%. Areas of Clinical Focus (the presenting problems) are covered through the case scenarios rather than as separate questions.
- Your score is the number of scored questions you answer correctly. The passing score is set by standard setting and equated across forms; NBCC does not publish a fixed number.
Sit the full exam under the real clock
11 case studies, 132 questions in 225 minutes, with sections that lock as on the real exam and a score for every domain.
Free case study drillHow our NCMHCE practice exam works
- 11 original case studies with 12 four-option questions each (4 per section), 132 questions in 225 minutes.
- 100 questions are scored in NBCC’s domain shares (15, 25, 15, 30 and 15). One whole case and 20 other questions are unscored, as on the real exam, and are marked in your review.
- Sections lock the way the real exam’s do: review and change answers within a section, then continue. Answers in earlier sections cannot be changed.
- The result shows your score on the 100 scored questions, your score in each domain, and every case with its narrative, your answers and an explanation for each question. Not simulated: NBCC’s 15-minute scheduled break (our clock keeps running) and its on-screen tools.
Change ahead: the July 1, 2027 NCMHCE
NBCC’s 2027 Examination Specifications describe a new NCMHCE from July 1, 2027: 10 case studies with 9–15 four-option questions each (130–150 questions, 30–50 of them field-test items), six new domains from the 2024–2025 work analysis, an optional 15-minute break halfway with each half submitted before it, and a scaled score from 100 to 500 with 360 to pass. Until that date the 11-case format above is the one in force.
Common questions
How many questions are on the NCMHCE?
130 to 150 multiple-choice questions across 11 case studies, 9 to 15 per case. 100 of them are scored. One case study and some other questions are unscored field-test items.
Can you go back on the NCMHCE?
Only within a section. Each case has three sections (intake and two sessions). You can review, flag and change answers in the section you are in; once you continue to the next section, you cannot return to earlier ones.
Is the NCMHCE harder than the NCE?
NBCC does not compare them. The NCMHCE asks you to apply knowledge to unfolding cases, so most of its questions are at the application level or higher, while the NCE mixes knowledge and application questions on 200 standalone items.
Does the NCMHCE use the DSM-5-TR?
NBCC lists the DSM-5-TR among the tools for its 2027 specifications, and case intakes give a provisional diagnosis. Our cases describe symptoms in our own words and ask diagnostic questions by disorder name, without quoting any manual.
11 case studies, 132 questions in 225 minutes, with sections that lock as on the real exam and a score for every domain.
Free case study drillMore NCE and NCMHCE practice
- Professional Counseling Orientation and Ethical Practice
- Social and Cultural Diversity
- Human Growth and Development
- Career Development
- Counseling and Helping Relationships
- Group Counseling and Group Work
- Assessment and Testing
- Research and Program Evaluation
- NCE practice exam (200 questions, 3 h 45 min)
- NCMHCE practice exam (11 case studies, 225 min)
Sources
- NBCC: National Counselor Examination (NCE) page
- NBCC: NCE Content Outline (domains, scored items, 200 questions in 3 hours 45 minutes)
- NBCC: NCE State Licensure Candidate Handbook (revised September 24, 2024): session timing, scoring, retakes
- NBCC: NCE Examination Specifications effective July 1, 2027
- NBCC: National Clinical Mental Health Counseling Examination (NCMHCE) page
- NBCC: NCMHCE Content Outline (revised October 8, 2025): case-study format and scoring
- NBCC: NCMHCE State Licensure Candidate Handbook (revised November 20, 2025)
- NBCC: NCMHCE format comparison chart (case-study format for licensure candidates from November 2022)
- NBCC: NCMHCE Examination Specifications effective July 1, 2027
- NBCC: National Certified Counselor (NCC) application fees
Original practice questions for exam preparation, written to NBCC’s NCE and NCMHCE content outlines in force, not NBCC exam questions. Independent practice, not affiliated with or endorsed by the National Board for Certified Counselors (NBCC), the Center for Credentialing & Education or Pearson VUE. NCE and NCMHCE are marks of NBCC.