NCMHCE Practice Questions (2026) — Free Sample Questions with Answers

Presenting Problem

You are a licensed mental health counselor working in a private practice. Simone, a 23-year-old staffing coordinator, schedules an intake after her boyfriend, Julian, walked in on her vomiting in their bathroom and told her he would not "pretend this isn't happening anymore." Simone says, "I've been hiding this for almost a year. I'm here because he made me promise, but I also know I can't keep doing it."

Simone reports that about 10 months ago, after she was passed over for a promotion, she started a strict diet: she skips breakfast and lunch and tries to eat only a small dinner. On about three evenings a week she eats far more than most people would in a similar time, such as a family-size box of cereal, a sleeve of cookies and leftover takeout within about an hour. "Once I start, I can't stop until I feel sick." After each binge she makes herself vomit, and she also vomits after some ordinary meals that include foods she considers "off limits." She estimates that she vomits about five times a week on average and has done so for at least the past six months. She denies laxative, diuretic or diet-pill use and says she exercises "normally."

Simone says her weight "has barely moved," and her primary care provider described her weight as in the healthy range at a physical about a year ago. Even so, "If I gain two pounds, the whole day is ruined. How I look decides whether I'm a good person or not." After a binge she tells herself, "I'm disgusting." Twice in the past month she has felt light-headed when standing up quickly, and once she noticed her heart "fluttering" at work; she has not told anyone. She spends about $60 a week on binge food, has been late to work several times after nights of bingeing, and now declines dinner invitations from friends because she "can't control what will be served."

When asked about safety, Simone denies suicidal ideation, intent or plan and denies any history of self-harm: "Sometimes I wish I could disappear for a week so nobody sees me like this, but I would never hurt myself." She denies homicidal ideation.

Mental Status Exam

Simone arrived on time, well groomed and casually dressed. She was oriented to person, place, time and situation. Her affect was anxious and constricted, congruent with her stated mood of "ashamed and worn out." Recent and remote memory were intact. Motor activity and gait were normal. You observed mild swelling along both sides of her jaw and small calluses on the knuckles of her right hand. Eye contact was good except when she described eating episodes, when she looked at the floor. Thought process was linear and goal directed; thought content was preoccupied with weight, shape and food rules. She denied perceptual disturbances, suicidal or homicidal ideation, and any history of mania or hypomania. She drinks two or three glasses of wine on weekends and denies drug use.

Psychosocial and Family History

Simone grew up with her mother and older brother after her parents divorced when she was 9. She describes her mother as loving but "always on a diet" and recalls her mother commenting on her body when she was a teenager. Simone competed in gymnastics through high school. She has lived with Julian for a year and describes the relationship as supportive but strained since he discovered the vomiting. She earned a business degree and has worked as a staffing coordinator for two years; her finances are stable, and she uses her employer's insurance for counseling. She was raised Catholic and does not currently practice. A trauma screen was negative. At the end of the intake she says, "Please don't call my doctor. She'll want to weigh me and run tests, and I'll freak out. Can this just stay between us?"

Presenting Problem

You are a licensed mental health counselor working in an integrated primary care clinic, where you see patients referred by the clinic's physicians. Walter, a 74-year-old retired high school chemistry teacher, is referred by his primary care physician after his annual visit, at which he had lost 15 pounds in a year and told the nurse, "I'm just marking time until I can be with Gene." Walter's husband of 31 years, Gene, died 14 months ago of amyotrophic lateral sclerosis (ALS) after Walter cared for him at home for nearly 3 years. Walter says, "Every day I wake up, and for a second I think he's downstairs making coffee, and then it hits me again." He describes a near-constant longing for Gene and says most of his day is spent thinking about him; he still sets out two mugs and talks to Gene's photo each evening. He says, "I know he's gone, but I don't believe it, if that makes sense." He avoids the diner where they ate every Sunday and drives miles out of his way to avoid the hospice office. He stopped singing in his community choir after Gene died: "Without him in the second row, what's the point?" He describes feeling "numb at the edges" and says life "stopped meaning anything when he did." He feels intensely lonely "every single evening." He eats poorly because "Gene was the cook," and the weight loss has been gradual. He sleeps about six hours, waking once, and says his energy is "fine for an old man." He enjoys weekly visits from his grandnephew and still reads the newspaper every morning. He describes himself as "a decent person who just lost his other half" and denies feeling worthless, though he feels some guilt for "not noticing his stumbling sooner." His PHQ-9 total today is 9. When asked about suicide, Walter says, "I don't want to die, exactly. Some nights I just don't care if I wake up." He denies a plan, intent, preparatory behavior or past attempts. He denies homicidal ideation.

Mental Status Exam

Walter arrives early, neatly dressed in a pressed shirt that now hangs loosely on him; grooming is good. He is alert and oriented to person, place, time and situation. Eye contact is good, although he looks down at his wedding ring when speaking of Gene. His mood is "empty"; affect is tearful when he discusses Gene and brightens when he describes his grandnephew, congruent with content. Speech is soft and normal in rate. Thought process is logical and goal-directed; thought content focuses on Gene and the years of caregiving. He denies hallucinations and says he talks to Gene's photo but has never heard a reply. Recent and remote memory are intact. Gait is slow but steady. He reports passive death wishes as described, denies plan, intent and homicidal ideation, and denies any history of mania. He has one glass of wine with dinner "some nights" and denies other substance use.

Psychosocial and Family History

Walter and Gene met in their early 40s and married as soon as they legally could. They had no children; Walter's niece and her 10-year-old son visit weekly, and his niece drove him to today's appointment. Gene's siblings, who "never accepted us," planned the funeral in Gene's hometown church and listed Walter only as "a close friend" in the obituary. Walter says, "They erased thirty-one years in one paragraph." He lives on a teacher's pension and owns his home. He describes himself as "spiritual, not religious." Friends from the choir call now and then, but he lets the calls go to voicemail. He has never been in counseling. His trauma screen is negative. He signed the clinic's integrated-care consent form at check-in but says he "just signed where they pointed." At the end of the intake, Walter asks, "Does Dr. Okafor see everything I tell you? I don't want my doctor thinking I'm losing my marbles."

Presenting Problem

You are a licensed mental health counselor working in a community counseling agency that serves veterans and their families. Lamont, a 38-year-old Army veteran who served two deployments as a combat medic, comes to intake at his wife's urging after she found him asleep in his truck in the driveway at 3 a.m. following a night of drinking. He says, "She thinks I'm falling apart. I think I'm just tired." Lamont left the military 3 years ago. He describes a convoy attack 11 years ago in which a soldier he was treating died. He says he "held it together" for years, but over the past 14 months, since a coworker was killed in a line-work accident, his symptoms have steadily worsened. He has nightmares about the convoy four to five nights a week, wakes "soaked and swinging," and now sleeps in a recliner so he will not hit his wife. When a truck backfires, "for a few seconds I'm back on that road, and I can smell it." He avoids war movies and unit reunions, has stopped watching the news and drives long routes to avoid overpasses. He says, "I love my daughter, but the feeling's switched off. I can't get it back." He startles at slamming doors, sits facing exits and checks the door locks two or three times a night. He blames himself: "A real medic would have stopped the bleeding." Several times a month, for a few minutes at a time and including on days he has not been drinking, "everything around me looks flat and fake, like a movie set." Lamont drinks five or six beers most nights "to get to sleep" and more on weekends; his AUDIT score today is 18. He has missed four shifts in the past 2 months and received a written warning. When asked directly about suicide, he says, "Some nights I think it would be easier to just not be here anymore, but I wouldn't do that to them." He denies a plan, intent or past attempts. He keeps a loaded handgun in his nightstand "for security." He denies thoughts of harming others.

Mental Status Exam

Lamont arrives on time, casually dressed and adequately groomed, with a healing cut on his knuckles that he says came from "punching the headboard in a dream." He is oriented to person, place, time and situation. He sits with his back to the wall and scans the room when the hallway door closes. Eye contact is intermittent. His mood is "worn out"; affect is constricted and congruent with mood. Speech is normal in rate and low in volume. Thought process is linear and goal-directed, and thought content centers on guilt about the convoy and worry about his job. He denies hallucinations and describes the "movie set" episodes with reality testing intact. Memory is grossly intact, though he reports poor concentration at work. Gait is normal, and his startle response is elevated. He reports passive death wishes as described, denies intent, plan and homicidal ideation, and denies any history of mania. Alcohol use is as described; he denies other drug use.

Psychosocial and Family History

Lamont has been married for 9 years and has a 7-year-old daughter. He works as a field technician for a regional electric utility; the company's employee assistance program (EAP) gave him the agency's name after his written warning. His father, also a veteran, "drank his feelings," and Lamont says he swore he would never be like him. He was raised in the Church of God in Christ and says his faith "went quiet" after his second deployment. He texts with a few soldiers from his unit but has not seen any of them in over a year. Money is tight since the warning put his overtime on hold. He has had no prior counseling and declined mental health services when he left the Army because "it goes in your record." His trauma screen is positive, and his PCL-5 total at intake is 54. At the end of the intake, Lamont asks, "If I tell you how much I really drink, does my job or the VA find out?"

Presenting Problem

You are a licensed mental health counselor working in a private practice. Mina, a 15-year-old tenth grader, is brought to counseling by her mother after the school counselor noticed that Mina eats lunch alone in a library study room most days. Her mother signed consent for treatment, and Mina agreed to attend "for now." Early in the interview Mina said, "My mom made me come. Talking about it doesn't fix anything."

Eight months ago, while Mina gave an oral report in history class, her voice shook and she lost her place. Two classmates recorded her, and the clip circulated in a class group chat with mocking comments; one of them still calls her "Shaky" in the hallway. Since then Mina has avoided speaking in class, refused two oral presentations (her history grade fell from a B to a D), quit the school orchestra after nine years of violin, and asks her mother to order for her at restaurants. When a teacher calls on her, she blushes and trembles, and her mind "goes blank." She says, "Everyone is just waiting for me to mess up again so they can laugh." She worries for days before any class where she might have to speak and has missed six school days this semester, usually with stomachaches on presentation days. She is comfortable talking with her one close friend, Ji-woo, at home, and says she was "pretty normal" before the video.

Her mother reports that Mina spends most evenings in her room scrolling the group chat and sleeps poorly on school nights. Mina says she sometimes wishes she could "just disappear for a while," but she denies suicidal ideation, intent, or plan and denies any self-harm. She denies homicidal ideation. Mina adds, "My mom thinks I'm being dramatic. She says she got teased too and got over it."

Mental Status Exam

Mina wore an oversized hoodie with the hood partly up; grooming and hygiene were adequate. She was oriented to person, place, time, and situation. She described her mood as "fine," while her affect was anxious and constricted, incongruent with her stated mood. Memory was intact, and motor activity and gait were normal; she sat with her arms wrapped around her knees and blushed when school was discussed. Eye contact was minimal, and she often looked at her phone. Her answers were brief, but her thought process was logical and goal directed. Thought content focused on fears of being judged and humiliated. She denied perceptual disturbances, suicidal or homicidal ideation, and any history of elevated or expansive mood. She denied alcohol, vaping, or other substance use.

Psychosocial and Family History

Mina lives with her mother, a nurse who works night shifts, and her 11-year-old brother. Her parents divorced when she was 7; her father lives out of state, and she talks with him by video monthly. Her mother emigrated from Korea as a young adult. The family speaks Korean and English at home and attends a Korean Presbyterian church, where Mina used to play violin during services. Before this year Mina earned mostly A's and B's. Her trauma screen identified the bullying and the video but no physical or sexual abuse. Her mother signed a release allowing you to exchange attendance information and school-based recommendations with the school counselor. As the intake ends, her mother steps out to move the car, and Mina asks quietly, "Are you going to tell my mom everything I say in here?"

Session 1

Mina has attended three weekly sessions, arriving late twice because her mother's night shifts ran over. You introduced the CBT model and taught her to complete thought records, and she brought two entries. One reads: "Situation: raised my hand in chemistry and my voice cracked. Thought: I knew everyone was thinking I sounded weird. Anxiety: 90." She has started eating lunch with Ji-woo twice a week. While pushing up her sleeve to show you a bracelet, Mina revealed several fresh scratches on her forearm. She said she scratched herself with an opened paperclip last weekend after a classmate reposted the video: "It makes the noise in my head stop for a little while. I don't want to die. I just needed it to stop." She asked you not to tell anyone about the scratches. That afternoon the school counselor emailed you asking for "your diagnosis and session notes" to support a request to let Mina record her oral presentations. Mina also told you she wants to rejoin the orchestra this year.

Presenting Problem

You are a licensed mental health counselor working in a community counseling agency. Marcus, a 38-year-old father, brings his 8-year-old son, Theo, to intake at the suggestion of Theo's pediatrician, who found no medical cause for his morning stomachaches. Theo's mother, a Navy officer, deployed overseas five months ago and is expected home in about seven months.

Marcus reports that about two months after she left, Theo began crying and clinging to him at school drop-off almost every morning. Over the past ten weeks Theo has missed nine school days because of stomachaches that "disappear by ten o'clock if he's home." Theo will not fall asleep unless Marcus lies down in his room, and he has stopped going to sleepovers and to his Saturday swim lessons unless Marcus stays on the pool deck. "He follows me from room to room. If I go out to the mailbox, he's at the window," Marcus says. When Marcus is late for pickup, Theo asks the office to call him again and again. Theo tells you, "What if something happens to Daddy while I'm at school? Then nobody would be home." He has nightmares "about once a week" about getting lost in a store.

His teacher reports that he is quiet during class discussions but plays easily with two close friends at recess. His reading grades have slipped because of missed days. Marcus notes that Theo also throws tantrums when asked to turn off video games, "but that's been going on since he was six." Theo denies wanting to hurt himself or anyone else, and Marcus reports no self-harm or aggression. Theo's mother calls by video about once a week, and Theo is "clingy and weepy for the rest of the night" after each call.

Mental Status Exam

Theo is dressed in a clean school uniform and appropriately groomed for his age. He is oriented to person, place, and time and knows he is visiting "the feelings doctor." He sits pressed against his father for the first ten minutes, then moves to the play table while Marcus stays in the room. His affect is anxious and brightens during play; he describes his mood as "scared sometimes." Eye contact is shy at first and improves. Speech, motor activity, and gait are age appropriate, and memory for recent events appears intact. Thought process is logical for his age; thought content centers on his parents' safety. He denies hearing or seeing things others do not and denies wishes to hurt himself or others. No elevated mood or substance exposure is reported.

Psychosocial and Family History

Theo is the only child of Marcus, a self-employed landscaper, and his mother, who also deployed once when Theo was 3. The family moved to the area 18 months ago and has no relatives nearby. Marcus describes the household as close and says money is "fine, just stretched" since he cut back his work hours to handle school pickups. The family attends a nondenominational church, where Theo enjoys the children's program. A trauma screen is negative. Marcus says that in a military family "you just suck it up," and he doesn't want Theo "thinking it's okay to fall apart." He signs the consent for treatment and, at the end of intake, asks that you tell him "everything Theo says" in individual sessions so he can pass it along to Theo's mother on their calls.

Session 1

Marcus and Theo have attended all three weekly sessions. In individual play sessions, Theo repeatedly builds a ship from blocks, sails it "far away," and sends a toy helicopter to search for it. Marcus reports that Theo missed three more school days this month and that the stomachaches still start around 7 a.m. on school days but not on weekends. When Marcus walks him into the classroom, Theo grips his arm, and Marcus usually stays 20 to 30 minutes "until he calms down." On days Theo stays home, he spends the morning at Marcus's side. This week Theo told you, "If I'm at school and something bad happens to Daddy, nobody will know." The school counselor left Marcus a voicemail asking to "compare notes" with you and to discuss putting Theo on a shortened school day. Marcus has not signed a release for the school. You gave Marcus psychoeducation about how avoidance and accommodation keep anxiety going and introduced the idea of a gradual school-return plan. Marcus says, "I just hate seeing him that upset."

Session 2

Over the past three weeks, Theo has attended school four or five days a week under a plan you developed with Marcus and the school counselor after Marcus signed a release. Marcus now says a quick goodbye at the classroom door, and Theo earns a sticker for each "brave morning." His morning stomachaches now last "a few minutes." In today's play session, Theo builds the block ship again, but this time he steers it into a harbor, lines up toy figures on the dock, and says, "They're all waiting, and now it's home." In the parent session, Marcus's eyes fill with tears: "I'm supposed to be the strong one, and I'm barely holding it together." He describes two months of low mood, waking at 3 a.m., and pulling away from friends. "Some nights after Theo's asleep, I have four or five beers just to switch off," he says, adding, "Honestly, some days I wonder what the point of any of it is." He has never seen a counselor himself.