NCMHCE Test Comprehension: What You’re Missing (and How to Fix It)
Have you ever been doing a practice narrative for the NCMHCE and felt like multiple answers sound good? If so, I promise you that you are not alone in that feeling. The National Clinical Mental Health Counseling Exam (NCMHCE) is a beast of an exam.
On one hand, it can feel like a session with real clients because it gives you a detailed story and multiple sessions. But for this exam, sometimes our experience can get us into some trouble. In order to be successful on the NCMHCE, you almost need to think like a student again.
This test isn’t just about knowing the content; it’s about applying it in the way the test wants. You can know every diagnosis, theory, and treatment plan, but you still lose points if you misread the narrative or miss what the question is actually evaluating. Learning to slow down, recognize patterns, and read for meaning is one of the fastest ways to raise your score.
After taking the exam myself and helping hundreds of other therapists prepare for the exam, I’ve picked up recurring mistakes. In this post, I’ll walk you through the most common errors I see and, more importantly, how to avoid them so you can confidently and clearly approach your next practice test (and the real one!).
NCMHCE Mistake 1 - Not Reading the Narrative
Why it matters: This might be a little controversial, but I’m team read the whole narrative. I find that when you don’t read the narrative, you can pigeonhole yourself with information, miss important details, and waste time going back and forth trying to find what you missed.
What to do: I would say read the narrative all the way through, but keep an eye out for key information: anything measurable, symptoms/behaviors, who or what else is being impacted, changes from session to session, and the session number. You can learn more about this in my blog on where to start when preparing for the NCMHCE.
NCMHCE Mistake 2 - Reading too Quickly
Why it matters: You’ll miss key information, which can lead to you having to go back and forth to the reading and lead to you making simple mistakes.
What to do: Read carefully the first time and give yourself a chance to retain it before heading straight into the narrative. Don’t be afraid to summarize what you just read.
NCMHCE Mistake 3 - Not Paying Attention to the Demographics
Why it matters: The demographics can give you insight into the questions that might be coming
What to do: Pay extra attention to the Clinical Issues, Provisional Diagnosis, Modality, and the Location, and don’t be afraid to refer back to these areas.
NCMHCE Mistake 4 - Ignoring the Mental Status Exam (MSE)
Why it matters: It often highlights any suicidal or homicidal ideation within the client.
What to do: Read it carefully and be willing to refer back to it as needed.
NCMHCE Mistake 5 - Ignoring the Session Number
Why it matters: It can help you decide realistic next steps.
What to do: Whenever you have a question that asks why/how/what in relation to the steps you should take, look at the session number. If it’s early on in working with them, focus on rapport. If more time has passed, it’s okay to get more direct.
NCMHCE Mistake 6 - Forgetting to Build Rapport
Why it matters: The client tends to respond better when rapport has been built.
What to do: For the first four sessions, you can typically focus on building rapport. Ask questions, explore, validate, normalize, and show empathy. Basically, do things that help you get to know the client better and build trust.
NCMHCE Mistake 7 - Missing Keywords in the Questions
Why it matters: The keywords can shape the entire meaning of the question!
What to do: Keep an eye out for recurring key words like best, most, least, not, first, next, during, always, never, and only.
NCMHCE Mistake 8 - Not Knowing the Main Ideas of the Theories
Why it matters: Theories is the largest category of the exam and makes up 30% of the questions
What to do: Spend some time reviewing the theories. Understanding them as a whole is important, but at the very least, I would make sure you know the main ideas and can tell what separates each theory from each other. If you need some extra help with theories, you can grab one of my theory study guides.
NCMHCE Mistake 9 - Not Putting Safety First
Why it matters: Safety always takes top priority.
What to do: Look for suicidal/homicidal ideation. If it’s present, conduct an assessment. If it’s not, consider ruling out medical causes for the client’s situation. If that’s not relevant, any type of physical harm is the next priority.
NCMHCE Mistake 10 - Not Knowing the Cultural Formulation Interview (CFI)
Why it matters: The NCMHCE really loves the CFI.
What to do: Be familiar with the CFI. Nine times out of ten, if the narrative references the client’s culture, the CFI is the correct answer.
NCMHCE Mistake 11 - Not Considering Play/Art Therapy with Clients
Why it matters: With kids and teens, it’s even more important to build rapport and connect with them.
What to do: If play therapy is an answer choice for a client who’s having a hard time getting engaged, don’t be afraid to pick it.
NCMHCE Mistake 12 - Not Asking Your Supervisor
Why it matters: This test loves for us to ask our supervisor whenever we’re not sure of something.
What to do: When in doubt, ask your supervisor. If that’s not an option, ask a colleague. If that’s not an option, do personal therapy. In that order.
NCMHCE Mistake 13 - Referring Out
Why it matters: This test considers referring out to be a last resort.
What to do: Talk to your supervisor or colleagues, or do a training. If something else can be tried before you refer out, do it.
NCMHCE Mistake 14 - Forgetting Limits to Confidentiality
Why it matters: Some locations and client situations have limits to confidentiality that can change the ways we should respond to the questions.
What to do: Refer back to the location and the client's age to see if there are any potential limitations.
NCMHCE Mistake 15 - Forgetting to Answer Both Parts of a Two-Part Question
Why it matters: The test loves putting multiple answers that sound good. If you’re not careful, you could end up picking one that only addresses part of the question.
What to do: Read carefully and make sure that both parts of the question are addressed and answered correctly.
NCMHCE Mistake 16 - Not Being Careful with Long Answers and Questions
Why it matters: They like to slip in information that may not be true or may not be relevant to the questions.
What to do: Whenever you see a long question or answer, make sure you agree with the entire statement. If there’s something that isn’t true or feels off to you, it’s usually not the one to go with.
NCMHCE Mistake 17 - Making Assumptions
Why it matters: This test loves for us to spell things out for them. If something hasn't been explicitly stated, we can’t assume it happened.
What to do: Focus on what the question is actually asking you. It can be easy for our experience to have us thinking multiple steps ahead, but don’t read into the questions.
Putting It All Together: From Comprehension to Confidence
When it comes down to it, mastering the NCMHCE isn’t just about knowing theories or diagnoses. It’s about mastering how you read the exam.
It’s asking: can you read carefully, think clinically, prioritize what matters most, and play the game the way we want you to? Once you start to think like the test, things will start to click for you. The keywords will pop out, and you’ll recognize their tricks and patterns. And soon, you’ll start showing up as the test-taker (and therapist) you’ve worked hard to become.
You already have the knowledge; now it’s time to fine-tune the skill of how you use it. So as you keep studying, don’t just review content; train your eyes and mind to truly understand the exam. That’s how you move from anxious guessing to confident choosing. Remember: you don’t need to know everything.
Reading the NCMHCE correctly takes practice—but you don’t have to figure it out on your own. If you’re ready to strengthen your comprehension and strategy, you’ve got options:
Grab my NCMHCE Theory Study Guide to learn how to navigate the most important information about the theories.
Join a free Study Hall, where we walk through real test-style examples together.
Or book a private tutoring session if you want personalized feedback on how you approach each question.
However you choose to prepare, remember: mastering how you read the exam is what turns uncertainty into confidence!
Think you missed points because you didn’t know enough?
Chances are, it’s how you read the NCMHCE that’s holding you back. I’m sharing the most common mistakes I see, and how to avoid them for good.