NBCC NCMHCE Exam Questions

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101.

Use the following case study to answer this question.

Was the client's suicide a deficit in the therapeutic relationship? 

  • No, there is no indication the therapeutic relationship was lacking 

  • Yes, most client suicides are due to a failure in therapeutic relationship 

  • No, as the client seems to have been suicidal from the beginning 

  • Yes, the client indicated that the relationship was not meeting her needs 

Correct answer: No, there is no indication the therapeutic relationship was lacking 

In this case, there was no indication or concrete warning sign about her suicide. It does not seem from the available data that the therapeutic relationship was lacking, and that there must have been some other cause outside the counselor's knowledge.

Most suicides are not failures in therapeutic relationships, and the client does not appear to have been suicidal from the beginning; nor did the client indicate the therapeutic relationship was not meeting her needs. 

102.

Use the following case study to answer this question.

The client asks when he will "get better." What is the most ethical reply? 

  • Explaining the counseling process

  • Deferring the question until a treatment plan review 

  • Reassuring the client that they will get better

  • Specifying a date when symptoms generally remit 

Correct answer: Explaining the counseling process

Ultimately, the question of when a client will "get better" is a very complicated one, involving the effort and motivation of the client, the rapport of the therapeutic relationship, and the skill of the counselor, among many other factors. It is unethical to promise a client that they will "get better," as that phrase may be undefined accurately between client and counselor, and results are never truly guaranteed. However, the process itself can be explained along with attention to the roles of clinician and client, which will give the client a way to look at the process that will probably help their sense of timing. 

It is best not to defer the question or reassure the client about specifics. 

103.

Use the following case study to answer this question.

If you have a similar background but overcame your issues, would you relay this to the client in terms of encouragement?

  • You might, after weighing potential risks and benefits 

  • No, self-disclosure is unethical 

  • Yes, your self-disclosure might be encouraging 

  • No, self-disclosure would be dangerous 

Correct answer: You might, after weighing potential risks and benefits 

The use of self-disclosure with clients is controversial. Many see it as a way to establish rapport and encourage or reassure clients in a genuine way, with others saying that it violates the therapeutic setting and is not necessary. In the end, individual counselors are able to judge for themselves whether self-disclosure would be valuable in a given case after weighing potential risks and benefits.

Self-disclosure is not necessarily unethical, nor is it necessarily dangerous. 

104.

Use the following case study to answer this question.

How would you handle the client's hesitation about the suicide question in the mental status exam (MSE)?

  • Follow up immediately with supportive questioning 

  • Defer investigation until your first session 

  • Make a careful note before proceeding 

  • Consult with the patient's family members

Correct answer: Follow up immediately with supportive questioning 

When suicidality is discussed, the counselor must be aware of any opportunity to open the discussion further. In this case, the client hesitated to answer the question about suicidal ideation, but this could have many reasons. It is probably best to follow up immediately and supportively to determine if there is any other information the client wishes to pass along regarding suicidal ideation.

Though it may seem trivial, the client may be at risk. Investigation should not be deferred, and though careful notes should be taken, this does not replace the need to investigate any suicidal ideation or potential suicidal ideation as soon as possible. Consulting with the patient's family members would not be advisable in this instance; it will most likely be sufficient to find out more from the patient. 

105.

Use the following case study to answer this question.

What would be an example of paraverbal communication in this case?

  • Rushed speech 

  • Delusional statements

  • Suicidal statements 

  • Perseverative speech 

Correct answer: Rushed speech 

Paraverbal communication consists of the part of verbal communication that is more style and mannerism than content. Such things as rushed speech, tone, and volume would be examples.

Delusional content and suicidal statements have not been expressed by this client, but neither is an example of paraverbal communication. Similarly, perseverative speech has more to do with pursuing a topic or line of reasoning than paraverbal expression.

106.

Use the following case study to answer this question.

Do the client's responses to interventions suggest changes? If so, what? 

  • No, the current interventions seem to be working 

  • Yes, as the client is having issues with compliance 

  • No, as the client has not had adequate time with the interventions 

  • Yes, as the client needs treatment for grief issues 

Correct answer: No, the current interventions seem to be working 

Changing a treatment plan once decided upon and begun should be done when necessary. There may be a need to add items or adjust existing items; in this case, the client seems to be adapting well to the treatment plan as indicated, having made progress by using the suggested interventions. 

It is not too early to change interventions if the interventions are ineffective. The client's grief may need assessment; though the topic should have engagement, there may not be a clinical need to address it. 

107.

Use the following case study to answer this question.

If the client asks for educational resources about his problem, which of the following would be most appropriate?

  • A fact sheet written in layman's language 

  • A peer-reviewed journal article about this problem

  • The client should get their education about their problem in the session itself

  • A website dedicated to trauma information 

Correct answer: A fact sheet written in layman's language 

It is encouraging if a patient wishes for resources or information about their problem. However, such resources should be carefully curated by the counselor to determine both their validity and their appropriateness for the client's educational level. In this case, the best option would probably be a fact sheet written in layman's language, as we do not know that this client has either any difficulty with reading comprehension or an advanced understanding of psychology. Clients should not have to get all of their information exclusively from their counselor in the course of a session.  

A peer-reviewed journal article about this problem may be written in language that is not easily accessible to a layperson, and may not contain easy-to-use information. A website dedicated to trauma information may or may not be appropriate for the level of this client's problem; he may not need resources specifically dedicated to trauma and such a website may be too dense for a person who has had sleeping difficulties and is afflicted by persistent worry.

108.

Use the following case study to answer this question.

Can this client benefit from cognitive behavioral therapy (CBT)?

  • Yes, to help bring awareness to distorted thinking patterns 

  • Yes, to help the client disclose past trauma 

  • Yes, to help the client desensitize to negative feedback 

  • Yes, to facilitate the building of a support network 

Correct answer: Yes, to help bring awareness to distorted thinking patterns 

Cognitive behavioral therapy (CBT) is most effective when it is used to help clients understand and address their own patterns of thinking and emotion. In this case, the client could benefit from understanding and awareness of his distorted thinking patterns, which likely contribute to other issues.

CBT would not be mainly used in this case to disclose past trauma, develop negative feedback tolerance, or help build a support network. 

109.

Use the following case study to answer this question.

After the second session, what is the main issue of concern? 

  • The client's increasing persecutory delusion

  • The client's noncompliance with treatment 

  • The client's decreasing delusion 

  • The client's apparent hallucinations 

Correct answer: The client's increasing persecutory delusion

Clients who have delusional disorder can be at risk when their delusions become persecutory in nature, or in situations where their false beliefs put themselves or someone else at risk. In this case, it's clear that the client's sense of persecution related to their delusion is getting worse, which may result in a heightened risk profile. 

The client does not appear to be noncompliant with treatment or experiencing hallucinations. The client's delusions do not appear to be decreasing. 

110.

What would a specialist in Cognitive Behavioral Therapy (CBT) most likely suggest for this client? 

  • Addressing negative thought patterns 

  • Psychoeducation

  • Family coping skills 

  • Substance use treatment 

Correct answer: Addressing negative thought patterns 

Cognitive Behavioral Therapy (CBT) specializes in the links between thought, emotion, and behavior. In this case, such a therapist might suggest studying the negative thought patterns present, their causes and effects, and means to reduce their harm. 

Psychoeducation, family coping skills, and substance abuse treatment are possibilities, but CBT specializes in addressing thought patterns. 

111.

Use the following case study to answer this question.

How should you handle the client's possibly being intoxicated for your session?

  • Gently confront the client about it 

  • Ask the client to come back another time 

  • Call the authorities immediately

  • Go on with the session as normal

Correct answer: Gently confront the client about it 

If you suspect a client is intoxicated in your session, the best course of action is to gently confront them about it in the moment. Simply asking the question will help you understand how to proceed. In most cases, it is probably best to have the client come back when they are not intoxicated, as the intoxication may include many elements of risk for both you and the client.

You may be asking the client to come back another time depending on how the conversation about use goes. It would be inadvisable to ignore what you believe to be intoxication on the part of your client. Notifying the authorities is probably not necessary unless the client seems to be in danger, or at risk of putting others in danger. 

112.

Use the following case study to answer this question.

What would be a psychoeducational strategy to help the client understand her diagnosis? 

  • Educating her about the link between anxiety, pregnancy, and pica

  • Educating her about pica in children

  • Educating her about the risks of substance use

  • Educating her about the need for support systems

Correct answer: Educating her about the link between anxiety, pregnancy, and pica 

Clients can often benefit from psychoeducation, which is the therapeutic technique which focuses on educating the client about their diagnosis. In this case, it would be useful to educate the client about the link between anxiety, pregnancy, and pica, as it will help her in her present circumstances with the new diagnosis.

The other items do not address her pica diagnosis directly, or do not address it appropriately to her.

113.

Use the following case study to answer this question.

Why would it be important for this client to learn communication skills? 

  • This client struggles with interpersonal interactions

  • To arouse empathy in the client for others 

  • This client has verbal language difficulties 

  • To help the client have more efficient conversations 

Correct answer: This client struggles with interpersonal interactions

This client has narcissistic personality disorder, meaning that (among other things), their interpersonal interactions are likely one-sided, self-centered, and ultimately less effective than they could be. Overall, persons with this disorder struggle in interpersonal interactions, especially those that call for vulnerability as we see above.

The point of this kind of skill training would not be to arouse empathy, and the client does not have verbal language difficulties per se. Helping the client have more efficient conversations is only part of the objective. 

114.

Use the following case study to answer this question. 

If the client is upset about being referred to you, what would be the most effective response? 

  • Empathize and try to explain the referral

  • Ask for the referral to be reconsidered

  • Deny the referral outright 

  • Explain why the referral should not be questioned

Correct answer: Empathize and try to explain the referral

In this situation, it is best to accept the referral, given what could be a situation you can help with. However, it is important to empathize with the nature of clients who feel as though they do not need to see you or have been mistakenly referred. This will help create rapport and clear the way to therapeutic work.

The referral should not be reconsidered or denied.

115.

Use the following case study to answer this question.

How long will this client likely stay in the hospital?

  • Until they are no longer a danger to themselves or others 

  • Until they are able to process their trauma appropriately 

  • Until they can fully recover from the diagnosis 

  • Until they can meaningfully participate in treatment 

Correct answer: Until they are no longer a danger to themselves or others 

In most jurisdictions, civil commitment is a matter of law whose finite duration is set by the standard of dangerousness to self or others. There are other aspects to civil commitment that differ from jurisdiction to jurisdiction. 

Civil commitment, in most cases in modern times, is meant to be short-term, and depends on follow up outside the hospital for such things as full recovery from a diagnosis or long-term processing of trauma. 

116.

Use the following case study to answer this question.

What is a symptom not mentioned that would be congruent with this client's diagnosis? 

  • Lack of concentration

  • Delusions 

  • Hallucinations 

  • Violent outbursts

Correct answer: Lack of concentration

Depression affects the individual sufferer's rhythms in many ways; sleeping, working, eating, and cognition are among the issues most affected. The client suffering from seasonal affective disorder is liable to changes in their ability to concentrate. 

The other symptoms are not characteristic of or diagnostic to depression.

117.

Use the following case study to answer this question. 

What would be the best use of a pre- and post-test with this client? 

  • To gauge the effectiveness of therapy with mood fluctuation 

  • To measure the level of the client's depression 

  • To assess the magnitude of the client's hypomania 

  • To understand the level of the client's suicidal ideation 

Correct answer: To gauge the effectiveness of therapy with mood fluctuation 

The use of instruments such as pre-and post-tests can be helpful in measuring client progress over time in one way or another. In this case, it may be helpful to understand how effective therapeutic interventions are on the client's fluctuations in mood over time.

Though finding out more about the client's depression, hypomania, and suicidal ideation are all important, these would be more point-in-time analyses as opposed to gauging the overall effectiveness of the treatment plan. 

118.

Use the following case study to answer this question.

Which of the following kinds of concurrent treatment would you recommend for this client? 

  • The client needs no concurrent treatment at this time 

  • The client could benefit from inpatient treatment 

  • The client could benefit from substance abuse monitoring 

  • The client needs to attend family therapy

Correct answer: The client needs no concurrent treatment at this time 

Though the client may seem to need treatment from his family's point of view, there is no indication that he needs adjunctive treatment or would attend it willingly if he did. 

There is no indication he is using substances, and though family therapy might have its benefits, it's clear that this patient does not want therapy and the therapy may be more of a burden to the client than a help. 

119.

Use the following case study to answer this question. 

What would be the best way to quantify this patient's level of anxiety?

  • With multiple rating scales over time 

  • At the first session by the client's report

  • Before and after the first session by client's report

  • At intake using a peer-reviewed scale

Correct answer: With multiple rating scales over time 

The focus of clinical attention in this case is the patient's anxiety. The hope is that with clinical intervention, that anxiety can be reduced or eliminated. It is very important to get a variety of readings on this anxiety both before treatment begins and continually as it progresses. Though objective scales will be necessary for clinical evaluation of progress, the patient's subjective self-report of symptom experience should not be disregarded and should be part of the overall narrative of treatment. 

Client reports are not sufficient to measure progress, as they usually contain only subjective data and are variable in many ways. The process should have a baseline obtained at intake and subsequent measures to ensure clinical progression.

120.

Use the following case study to answer this question.

What is the most likely cause of the client's strange belief as expressed during intake?

  • A normal attempt at making sense of her symptoms

  • A delusional break from reality 

  • An attempt to avoid legal responsibility 

  • An expression of schizophrenia 

Correct answer: A normal attempt at making sense of her symptoms

Most people attempt to make sense of events that do not make sense to them, especially in cases where something strange has occurred, such as the loss of a set of memories. In this case, the client does not appear to have a fixed and unshakable belief that they are in the afterlife and has only offered it as one (albeit strange) way of explaining a highly traumatic event. 

There is no indication that the client is attempting to avoid responsibility, nor is the expressed belief a delusion characteristic of schizophrenia.