Guide to the National Counselor Examination (NCE)

Anyone who aspires to become a Licensed Professional Counselor (LPC) or a Licensed Mental Health Counselor (LMHC) will inevitably take the National Counselor Examination (NCE). While each state has different requirements for licensure, the NCE is a comprehensive test by the National Board of Certified Counselors (NBCC) throughout the United States.

Of its 200 multiple-choice questions, only 160 are actually scored. The other 40 are used for research purposes to identify which items should be used on future exams. However, you won’t know which is which, as they’re all mixed in.

Since psychology is such a vast subject, the questions in the NCE were developed by analyzing over 16,000 credentialed counselors to determine what information is most relevant to maintaining a competent mental health practice. This breaks the 160 questions on the NCE into six domains.

Professional Practice and Ethics

Accounting for 19 questions, this domain covers a broad scope of professionalism, from clarifying the counselor and client roles, rights, and responsibilities; to confidentiality, informed consent, supervision, and consultation; to the importance of providing accommodations to the differently abled. 

Exploring the finer points of business, this domain also addresses payment policies, fees, and insurance, as well as record keeping and how best to maintain and protect documentation. These competencies ensure that counselors adhere to safe and just policies that align with overarching federal law.

Intake, Assessment, and Diagnosis

This domain also accounts for 19 questions and reviews the skills and knowledge required for a client intake and preliminary assessment. This includes how to conduct an initial interview, a biopsychosocial interview, a Mental Status Exam (MSE), a diagnostic interview, and a cultural formulation interview while also assessing social dynamics and watching for at-risk behavior. It also explores how to make an official diagnosis, conceptualize co-occurring mental health disorders, develop and implement a treatment plan, and assess outcomes.

Areas of Clinical Focus

Taking up 47 questions on the test, this domain covers a broad spectrum of mental health issues across the lifespan. This includes everything from child development and gender identity; to adjustment issues and behavioral problems; to the impacts of bullying, abuse, racism, and discrimination. Anxiety, depression, PTSD, OCD, eating disorders, and substance abuse are just a handful of the diagnoses you will be tested on. 

This domain may also cover career management and guidance counseling; family planning and family systems; as well as end-of-life concerns and grief counseling. As one of the longest portions of the NCE, Areas of Clinical Focus prepares mental health counselors to conceptualize the multifaceted identities of their clients and, in turn, the intersectional issues they face.

Treatment Planning

Surprisingly, this domain is only 14 questions, but they are rigorous, so don’t neglect this subject. To make sure a counselor can develop and implement an effective treatment plan, these questions address how to build rapport and establish goals with the client; how to navigate barriers and obstacles to these goals; and how to develop a support team. This domain also delves into working with outpatient, inpatient, and residential clients; how to refer out as needed; and how to transition and discharge clients.

Counseling Skills and Interventions

As the longest part of the test, Counseling Skills and Interventions takes up 48 questions. This domain explores how to align and adapt a therapeutic modality to work with different populations, developmental levels, and cultural demographics. It dives into family systems, religious and spiritual values, cultural considerations, addiction patterns, crisis intervention, conflict resolution, communication skills—all while developing trust and safety, navigating transference, and working towards desired change. 

This domain is comprehensive, as it also explores techniques like cognitive reframing, present-based mindfulness, constructive confrontation, empathic responses, and the use of self-disclosure. Brush up on Irvin Yalom as it also tests group therapy skills like linking and bridging, psychoeducation, and social role modeling.

Core Counseling Attributes

Turning the focus around, the last 13 questions explore the traits and behaviors of the counselors themselves. This means taking a look at your level of awareness, genuineness, empathic attunement, and congruence with the client since the counselor’s warmth and disposition directly impact the client. 

This domain also explores the counselor’s knowledge and sensitivity to sexual orientation, gender identity, and multicultural diversity by gauging their positive regard and non-judgmental stance. As much of this content originates from humanistic psychology, this domain also focuses on foundational listening, attending, and reflecting skills needed to be truly present with a client.

Preparing for the NCE

The six domains of the NCE also align with the eight content areas maintained by the Accreditation of Counseling and Related Education Programs (CACREP):

  1. Professional counseling orientation and ethical practice
  2. Social and cultural diversity
  3. Human growth and development
  4. Career development
  5. Counseling and helping relationships
  6. Group counseling and group work
  7. Assessment and testing
  8. Research and program evaluation

This means a CACREP-accredited master’s or PhD program should cover the main concepts on the NCE. The whole purpose of CACREP and the NCE is to make sure that aspiring mental health counselors are drawing from a well-rounded base of knowledge. But how does this play out in real world settings, when colleges and universities offer unique educational opportunities?

The truth is that some counseling programs may emphasize research methodologies, family dynamics, or trauma-informed therapy. Some may also be famous for a particular modality, leading the field in cognitive behavior therapy, somatic therapy, or psychodynamic therapy. 

As a psych major, you also may have a particular area of focus in your research studies or internship experience, leading you to work with a certain age range, demographic, or mental health area. As a result, it’s not uncommon for those who take the NCE to find that their professors and mentors covered some of the content in depth, while barely touching on the rest. Don’t panic. That’s perfectly normal.

As the Chinese philosopher Confucius once said, “To know what you know, and to know what you don’t know, is the characteristic of one who knows.” So the best way to prepare for the NCE is to take a practice test, to learn where you excel and where you need more study. There are many study-guides, flashcards, textbooks, audiobooks, and online practice tests available, including the NBCC Foundation’s official study guide; the study guide and flashcards by Mometrix, NCE Test Prep or NCE Exam Prep; and of course Dr. Howard Rosenthal’s User-Friendly Exam Prep

When you’re feeling ready to take the test, you will need to create an account or log in to NBCC to register. You will want to do this well in advance, as Pearson Vue administers the NCE, and there are only so many Pearson Vue test centers in each state. Also, there are limited seats available, and the test is only conducted twice a year in the spring and fall. Currently, the application fee is $275.

What to Know The Day You Take the NCE

To be administered to the test, you will need two valid forms of ID, one of which must be a government-issued ID with your name, photo, and signature, like a driver’s license or a passport. The other ID must also have your name and signature or your name and a recent photo. Pearson Vue will also take a photo of you to be recorded with your test results and may even ask for a palm scan as a biometric security measure.

Obviously, they do not allow phones, cameras, notes, tape recorders, or calculators into the computer room, and they may ask you to leave any such items in a locker or a safety box while you take the test. As an extra precaution, the Pearson Vue center will also ask you to turn your pockets inside out, roll up your sleeves, pull back your hair, and check your hood, tie, or waistline to make sure there are no electronic devices or concealed objects. If you wear glasses, they may inspect them for the same reason. This is a pretty casual procedure, so don’t stress about it, and if you’d like to see how easy it is you can watch this video provided by Pearson VUE

When you’re in the computer room you will have three hours and 45 minutes to take the test, and while you can take a break, the clock doesn’t stop ticking. They will provide you with a notebook, and you will be monitored and recorded throughout the exam. If you are differently abled and need certain accommodations, review the NBCC Special Examination Accommodations Policy and fill out the Accommodation Request Form ahead of time.

Since the test is taken on a computer, you will know if you passed the NCE almost immediately. If you need to take the test again, you will have to wait three months to retest, meaning you will have to re-register and pay another $275.

What’s Next?

Once you pass the exam, you get to congratulate yourself and take some much-needed self-care time! Seriously, you deserve it!

The results of the NCE are good for three years, during which you will need to submit them with the rest of your application to the NBCC to become a National Certified Counselor (NCC). To maintain the NCC, every year, you will need to complete some continuing education (CE) hours, complete an ethics attestation, and pay an annual fee. The NCC is a point of pride for many mental health practitioners, who may hold the NCC in esteem as evidence of their education. It can also be very useful to pre-licensed mental health counselors when applying for a job.

However, the NCC may or may not be relevant to your state licensure, which will have its own application process, including a criminal background check, your transcripts, your practicum and supervision hours, and of course, the results from your National Counseling Examination.

Alex Stitt, LMHC

Alex Stitt, LMHC

Writer & Contributing Expert

Alex Stitt is a nonbinary author, queer theorist, and licensed mental health counselor living in Hawaii. As a proud Queer Counselor, they work to educate professionals in the mental health field interested in working with LGBTQ+ populations. Their textbook, ACT for Gender Identity: The Comprehensive Guide, demonstrates how to apply Acceptance and Commitment Therapy to gender self-actualization.