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Boost Your NCMHCE Test-Taking Success With These Strategies
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Boost Your NCMHCE Test-Taking Success With These Strategies

By Bonnie Bullard, PhD, LMHC, and
Linda Lawless, LMHC, LMFT 
Psychotherapists Training Institute (PTI)

So you have to take the NCMHCE (National Clinical Mental Health Counseling Exam). We say “have to” because no one we know has taken it for fun. Usually people take it because they want a license to practice their vocation, they have to take it to keep their job, or because they know getting their license will open new professional doors. 

Successfully passing this exam takes skill. To pass the exam, you must understand what skills are needed, practice, and prepare for success. Identifying your expertise in the required content areas and becoming familiar with the structure of the exam will tremendously enhance the possibility of your success.

The Exam Is Not About Your Personal Worth

It’s not about your expertise as a counselor either. It is an examination on a particular body of knowledge, written by a group of people with a particular perspective. You are being tested on how well you can bring your knowledge and experience to this exam. Try to keep your personal issues out of the process. Just learn the material and answer in a way you believe is correct. 

There are many reasons why people question their ability to pass the exam. Here are just a few we are used to hearing:

  • I’ve just graduated and don’t have much practical experience.
  • I’ve been practicing for some time now but don’t remember my academic training.
  • I’m steeped in my specialty (for example, dance or music therapy), and I don’t understand the philosophy of the exam.
  • I don’t believe in giving people a diagnosis.
  • I’ve been working in clinics and don’t understand private practice.

All of these reasons are valid, and even if one of them resonates with you, you can still pass the exam. It’s like you’re a sailor being tested on riding a bicycle. All you have to do is take some lessons in bike-riding, use whatever appropriate skills you’ve learned sailing, practice-practice-practice, pass the exam, and go back to sailing.

Understanding the Structure of the Exam and What It Tests

Over the years, PTI (the Psychotherapists Training Institute) has trained hundreds of potential licensees to pass the NCMHCE. What we’ve discovered and learned from our students is that those who pass the test are generally those who are successful at integrating their education, experience, and knowledge with an understanding of and comfort with the structure of the exam. 

One of the biggest obstacles is that the NCMHCE exam design is unfamiliar to most of us. The latent-image clinical simulation format is structured to replicate a clinical therapy session, and to determine if you are ready to be in independent professional practice. We believe that NBCC (National Board for Certified Counselors) has done a good job of that. So let’s look at the skills you’ll need to pass.

Skills: The exam assesses two general types of skills—Information Gathering (IG) and Decision Making (DM). You must ace both of these skill sets to pass the exam. For example, an IG section would require you to identify what information you would need to determine a diagnosis or create a treatment plan. A DM example is when you identify a diagnosis or choose an appropriate referral for the client at termination. 

Underlying these two skills are your knowledge base in the content areas and your expertise in case development. The exam consists of 10 “simulations,” with several sections giving a cumulative score in both. If you bomb on one simulation, you can still make up points with the ones that follow.

Content: The content areas identified by NBCC include: Counseling Theories, Special Treatment Issues, Substance Abuse, Psychopharmacology, Outcomes, Career Development, and Fundamentals such as growth and development. When scores are reported, the content areas are collapsed into these three aggregates: Assessment, Diagnosis and Treatment Planning, and Professional Practice.

A good understanding of case development is important since you do some things at the beginning of a case that differ from a successful termination and maintenance of a successful treatment experience.


To make this exam even more of a challenge, every choice you make is scored—positive or negative. This is very different from True/False or multiple choice exams, in which you receive points for correct selections and are not penalized for incorrect selections. 

Given this structure, you must be very strategic with your choices because a correct selection that gives you a positive score and an incorrect choice that gives a negative score can cancel each other out. For example, if you choose the same number of correct answers and incorrect answers, you can end up with a score of zero. 

We’ve had many new counselors contact us because they’ve taken the exam and failed. Often what we find is that they have an excellent knowledge and experience base, but were unfamiliar with the exam structure and chose too many answers, and the wrong ones reduced their score.

Some Suggestions for Studying

We recommend studying with others so you can hear different approaches to case development. The study process we’ve found to be helpful is:

  • Choose a case from a DSM Casebook
  • Develop your own case development that includes assessment, diagnosis, and treatment planning
  • Then check the Casebook and Treatment Planner books to see what you’ve missed.

This group study process, along with instructions for virtual study groups, is free online in the PTI Newsletter

To enhance your retention of material, skim the material for the central points and highlight them; put them in your MindMap or outline them. Re-read the material and add a new level to your MindMap. But don’t get bogged down recording all the details! If you want to review for more detail, then make flashcards.

Try making memory chains—for each word or concept, create an inner graphic picture of it. The more bizarre the image, the easier it will be to remember the image and the concept.
To become familiar with the exam structure, we highly recommend NBCC’s NCMHCE study guide and PTI’s ExamAce to help you understand the exam’s approach. We also strongly recommend that students read the NBCC Ethical Guidelines so they know the value structure that underlies the entire exam.

Give Yourself the Best Chance for Success

Finally, we have found that the greatest obstacle to successfully passing the exam is your ability to access your wisdom. Your exam anxiety is your worst enemy. When you sit for your exam, if you are clear about your skills, understand the structure of the exam, and do not get into an argument with the way the exam is unfolding (the exam always wins), you are in the best possible position for success. 

And if you don’t pass, don’t give up! Persevere—look at your scores, identify your weaknesses, study and practice, and take the exam until you pass!

Dr. Bullard’s teaching and psychotherapy career spans 30+ years. She believes counseling is teaching new life skills and ways of being in the world. Her philosophy is that her job is to work herself out of a job. Helping develop PTI, co-authoring its textbook, and teaching the PTI workshop encompass that philosophy. 

Linda Lawless, LMFT, LMHC, licensed 30 years, is an author, consultant, psychotherapist, and trainer. Her mission is to help professionals create practices that are as good for them as they are for their clients. Through PTI she helps qualified clinicians pass their exams so they can move into professional success. 

For more on PTI, click here.