My Best Tips for Passing the NCMHCE: What I Wish I Knew
If you learn better through listening, here’s a video of me walking through the test tips instead!
If you’re here, chances are you’re somewhere between stressed, stressed, and even more stressed. I know I was when preparing for the National Clinical Mental Health Counseling Examination (NCMHCE).
I remember staring at counselingexam.com for the first time and feeling so overwhelmed that I didn't open it again for three months. The NCMHCE is unlike any exam I’ve taken before—and if you're feeling overwhelmed, you're not alone. After passing on my first attempt and supporting dozens of students through this journey, I’ve gathered the strategies that actually work!
Whether you’re studying between clients, juggling parenting, or squeezing in time after work, this blog is for you. Passing the NCMHCE doesn’t require perfection. It requires strategy, understanding the test’s rhythm, and learning how to apply what you already know!
The Best Way To Start Studying for the NCMHCE
Make sure to prioritize the theories and the disorders!
These two areas make up the largest domains on the exam, so it is not the place to cut corners. The theories section is officially called “Counseling Skills and Interventions”; it makes up 30% of the exam. The disorders are called “Intake, Assessments, and Diagnosis” and officially make up 25% of the exam. However, I find that the “Treatment Planning”, 15% of the exam questions, have a lot of overlap with the diagnosis questions, so I would say the disorder-related questions are actually 40% of the test. That means 70% of the exam is related to theories and disorders!
Don’t forget the Narratives and Practice Exams.
Counselingexam.com has a huge variety of practice narratives. I find Set 10 through Groups is most helpful for passing the exam. It gives you a good variety of modalities and practice scenarios so you can have a little bit of everything.
I would also do at least 3 full exams before you take the real test. The NCMHCE is very long and detailed. Doing practice exams will help you build stamina, identify some of your weaknesses, and get yourself more comfortable with the formatting.
Study Extra Sections You Find Yourself Struggling With.
For the remaining two domains on the exam, “Professional Practice and Ethics” and “Core Counseling Attributes”, it’s most helpful to do the narratives and make adjustments based on that. I’ve noticed that when we get a question wrong, it’s usually for one of two reasons.
Reason 1: We weren’t reading carefully!
Do you ever review your answers and just shake your head for missing something that seemed so obvious? I get it! It still happens to me, and it’s been two years since I took it! Sometimes we’re just reading too quickly. Other times, we made assumptions or were overthinking a question that was actually straightforward. It can be annoying, but it’s a good reminder to read more carefully!
Reason 2: We have no idea what the question is talking about…
I’ll be honest, there are still times when I look at the correct answer and think, “I’ve never even heard of that before”. Our field is huge and always evolving, so it makes sense that you may feel like this, too. When this happens, make a note of it and then set aside some time to learn a little bit more about the topic!
Aim for Scores in the 70s Consistently
Passing scores in this exam are not state-dependent. Someone could be taking the NCMHCE right next to you and have a different version of the exam with a different passing score. I’ve seen the scores range from 59 to 66. This means we don’t need to be stressing ourselves out to try to get 100! However, I would at least aim for the 70s. This way, you can practice aiming higher and give yourself a little bit of a cushion.
When Studying The NCMHCE Theories
When it comes to the NCMHCE, you really want to know your theories well. You don’t need to know everything, though. Some of these theories have entire textbooks written about them, but there are five key things you should keep in mind.
Look for the objective/main idea/goals.
Know the founder or the main people involved in the theory.
Know the techniques that go with the theory.
Take note of the way the therapist interacts with this theory.
Pay attention to which disorders/dynamics the theory is helpful for.
I know this can still feel like a lot, but it’s worth it. If you’re still needing some extra support with the theories, you can grab one of my theory study guides to help you focus on what’s most worth it!
When Studying the NCMHCE Diagnoses
The disorders are another big part of the NCMHCE. If you’re using counselingexam.com, you definitely don’t need to bust out the DSM-5, but there are some key things you want to focus on.
Know the minimum duration criteria for symptoms.
Keep in mind the clinical terms and definitions for different symptoms.
Take note of how many symptoms are occurring
Be very familiar with differential diagnoses.
I find the Diagnostic Trees on counselingexam.com to be a great place for practicing diagnosing. It has little mini case studies that help you focus on the key symptoms and be able to better navigate the differential diagnoses.
Areas to Focus on in the Demographics
Now we’re getting into the actual narrative itself. At the top of a narrative, there’s a section with the client’s demographic. We do want to make sure we read the whole thing, but there are four areas in particular that we want to pay extra attention to.
1. Clinical Issues - This may also be called the presenting problem.
This tells us what the main focus of the narrative will be. Other things will likely come up, but this is the most important
2. Provisional Diagnosis.
The keyword here is Provisional. We want to read the narrative to see if we agree that this diagnosis is correct. Sometimes the questions will ask us how we know the provisional is right. Other times, it will ask us to compare it to a differential diagnosis. At times, it will ask for a co-occurring or comorbid diagnosis. And in rare instances, it may say that the provisional is incorrect, and what the diagnosis should be instead.
3. Modality.
The most common modality on the exam is Individual Therapy, but you may also see Family Therapy, Couples Therapy, and Group Therapy. It’s always helpful to double-check this, but even more so when the client is a minor. There will be times when the caregiver is in the session as well, even if the modality is Individual Therapy. In those instances, you want to be careful to keep the focus on the child.
4. Location of Therapy.
This can help with some of the confidentiality considerations. Different locations could be School, where we might be part of the IEP or 504 plan. Employee assistance program (EAP), where if the supervisor is referring them to therapy, we have to share limited information, but if the client is using their benefits voluntarily, we don't have to share information. A community center or agency tends to be where we see clients who are court-ordered to attend therapy. Hospitals and in-home therapy also have their own considerations. Then we have private practice, which tends to be the most strict, and we need to have a release of information (ROI) whenever we need to talk to anyone outside of the client.
When Reading A Narrative
I would say this section is the most important one to keep in mind! I am team read the narrative before answering the questions. Every time you read a narrative, you want to be looking for these things.
1. Look for what’s measurable.
Frequency, lengths of time, ages, amounts, and durations are all things you want to be looking for. This can help speak to the intensity or severity of what’s going on for a client. There’s a big difference in a client experiencing something for the past 3 weeks compared to the last 3 years.
2. What symptoms/behaviors are currently occurring?
What do we see going on in the session? What is the client reporting to us? Does this match up with the provisional diagnosis? These will be the best indicators of where the provisional is correct.
3. Who or what else is being impacted besides the client?
This can be friends, family, work, school, or hobbies. This can help speak to the functioning levels for the client. With mood disorders, personality disorders, behavioral disorders, and substance use disorders, we tend to see widespread impacts on the people and things around the client. Pay extra attention here because they like to ask questions about these seemingly small details.
4. Any changes in behavior?
When you get to the next session, you want to see if anything has changed from the previous session to the current one. Is the client getting better? Are they getting worse? Is something brand new going on? If the answer is yes, there will definitely be questions about it!
5. What session number are you currently on?
Lastly, you want to pay attention to the session number. We always start with the first session or the intake session. After that, the session number can vary. It can be session 2 or session 9. For the first four sessions, I would encourage you to focus on building rapport with the client. Ask questions, validate, explore, and build trust. I would not pick an answer that has to do with confronting the client this early on. The exception to this is if it is an EAP client or if the narrative specifically mentions that we have a limited number of sessions with the client.
When Answering Questions
When you start answering the questions, it will be helpful to keep these things in mind:
1. Put the question into your own words to make sure that you understand it.
This exam is very wordy! Don’t be afraid to break it down and make sure you actually understand what they’re asking you. It will save you a lot of time and headaches.
2. Try to narrow down the answer choices without going back to re-read the narrative.
Going back and forth throughout the narrative is one of the easiest ways to run out of time. Slow down and give yourself a chance to see what you’ve retained before you decide to go back to double-check.
3. Imagine how you would respond if this were a real client of yours.
I would only do this if you’re stuck between two answers. This exam is not real life. They want you to do things “by the book”, but in the moments when you’re really not sure, use your experience.
4. Go with your gut.
So often, I see people second-guess themselves or talk themselves out of the correct answer. I would rather you go with your gut and maybe get it wrong than spend a significant amount of time going back and forth between answers.
5. Only change your answer if you realize you read the question incorrectly.
I don’t even recommend reviewing your answers. Sometimes they plant traps that will make you feel like you answered a previous question incorrectly. Unless you missed a keyword in the question, do not change your answer.
6. If you’re not sure of the answer, make your best guess instead of leaving it blank.
Please don’t leave anything blank. This version of the NCMHCE no longer penalizes you for answering incorrectly. If you’re almost out of time, go back to the old faithful and mark everything C if you have to. But really really make sure you didn’t accidentally skip a question before moving onto the next section.
Key Words to Notice in the Questions
Keywords are your friend! They will make navigating this exam so much easier.
Best, Most, and Least.
When you see these, just know that on the surface, at least three of the answers will probably sound good. Break down the question and see if you can find what they specifically want you to focus on. I like to call this the target. Also, make sure you don’t miss the word least, it’s not as common as best and most and can be easy to miss!
Not.
This is a tiny but powerful keyword. It gets skipped over all the time, but it can completely change the meaning of the question. Whenever you see this keyword, double-check your answer to make sure you factored it in.
First, Next, During, or Within.
These keywords are very literal. When you see them, they are either referring to safety (suicidality, homicidality, or physical wellbeing) or it is referring to the order of operations. Slow down when you see them and really be careful not to make assumptions or skip steps.
Always, Never, Only, and Except.
These keywords do not leave any room for exceptions. When answering these questions, make sure that you agree with the entire answer if you’re going to pick it. Sometimes the exam likes to slip in one or two words that can turn an otherwise good answer into the wrong one.
Long Term vs Short Term Key Words
These keywords are also present in the answers themselves.
Long-term goals are things that can be realistically achieved in 30 days or more. Their keywords are more permanent-sounding and include things like:
Eliminate.
Establish.
Abolish.
Achieve.
Accomplish.
Short-term goals are things that can realistically be achieved in 30 days or less. Their keywords are more incremental and include:
Lessen.
Improve.
Increase.
Decrease.
Reduce.
There You Have It! You’re Ready to Pass The NCMHCE!
These are all the things I figured out the hard way while preparing for the NCMHCE, but they really work! If you’re intentional about paying attention to these things while studying, you’ll have what you need to be successful!
If you still need more support, join us for a free study hall session where I break down these tips in more detail and we do a narrative together as a group.
You can also sign up for my free newsletter to get weekly test tips sent directly to your inbox!
Please remember, this exam doesn’t define your worth or your ability to be an incredible counselor. It’s just one step in your journey. With the right mindset, strategy, and support, you’ve got this. Take a deep breath, trust your preparation, and keep going!
