NCE
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NCE is a trademark of its owner, which is not affiliated with and does not endorse Test Treasure Publication or TTP Prep.
10 sample questions for the NCE, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.
Sections covered on the exam: Professional Practice And Ethics, Professional Practice and Ethics, Intake, Assessment, and Diagnosis, Treatment Planning, Core Counseling Attributes and Foundations, Intake, Assessment, And Diagnosis, Intakeandinterviewing, Riskanddiagnosticprocess, Areas Of Clinical Focus, Moodandanxietydisorders, Traumaandrelateddisorders, Psychoticandpersonalitydisorders, Substanceuseandaddiction, Otherclinicalconcerns, Treatmentplanning, Treatmentmodalities, Progressandtermination, Counseling Skills And Interventions, Counseling Skills and Interventions, Theoriesandtechniques, Groupcounseling, Core Counseling Attributes, Self-Awarenessandself-Care, Multiculturalcompetence.
Question 1 · Professional Practice And Ethics
A counselor realizes that a new client is the ex-spouse of the counselor's close friend. The client asks to begin counseling anyway. What should the counselor do FIRST?
Answer: B. Discuss the conflict of interest with the client and offer a referral
A pre-existing personal connection creates a conflict of interest that can impair objectivity. The counselor explains the concern and offers a referral; client consent alone does not remove the risk, and contacting the friend would breach the client's confidentiality.
Question 2 · Riskanddiagnosticprocess
Before diagnosing a client with generalized anxiety disorder, the counselor learns the client drinks eight cups of coffee a day and recently started a thyroid medication. What should the counselor do?
Answer: C. Consider substance- or medication-induced anxiety and consult the client's physician
Differential diagnosis requires ruling out the effects of substances, medications, and medical conditions before diagnosing a primary anxiety disorder. Heavy caffeine use and thyroid medication can both produce anxiety symptoms.
Question 3 · Psychoticandpersonalitydisorders
A client describes a long pattern of intense, unstable relationships in which she idealizes new partners and then feels they are "worthless." She makes frantic efforts to prevent being left, has chronic feelings of emptiness, and shifts rapidly between rage and despair within hours. Which personality disorder BEST fits this presentation?
Answer: C. Borderline personality disorder
Frantic efforts to avoid abandonment, alternating idealization and devaluation, chronic emptiness, and marked affective instability are core features of borderline personality disorder. Histrionic personality disorder centers on attention-seeking and shallow emotion, and narcissistic personality disorder centers on grandiosity, need for admiration, and lack of empathy.
Question 4 · Progressandtermination
A counselor tracks a client's depression with the PHQ-9 at each session. 1 19 4 17 8 18 12 18 What is the MOST appropriate next step?
Answer: A. Review the plateau with the client and revise the plan, possibly with consultation or referral
Measurement-based care uses routine scores to detect a plateau so the counselor can reassess and adjust treatment collaboratively. Continuing an ineffective plan unchanged is not in the client's interest, and dropping measurement would remove the information needed to guide the next decision.
Question 5 · Theoriesandtechniques
Parents who are in chronic conflict each vent to their 14- year-old son about the other parent. The son has begun failing classes, and the parents now spend most of their time together discussing his grades. A Bowen family systems counselor would MOST likely describe this pattern as:
Answer: D. Triangulation
In Bowen theory, a two-person system under stress pulls in a third person to reduce anxiety, forming a triangle; the son's problems now absorb the tension between the parents. Emotional cutoff is managing unresolved fusion by distancing from family, and enmeshment is a structural family therapy term rather than a Bowenian concept.
Question 6 · Professional Practice And Ethics
A counselor is unsure whether to share information with a client's spouse, who is paying for the sessions and keeps calling for updates. The counselor decides to use the Forester-Miller and Davis ethical decision-making model. What is the FIRST step?
Answer: B. Identify the problem by gathering the facts and clarifying its nature
The model begins by identifying the problem and clarifying its nature before looking to the Code. Applying the ACA Code is the second step, and generating courses of action comes later, after the dimensions of the dilemma are understood.
Question 7 · Riskanddiagnosticprocess
A 16-year-old client reports cutting her thighs several times a week "to make the pressure go away" and denies any wish to die. Which statement BEST guides the counselor's assessment?
Answer: B. Self-injury usually regulates emotion but predicts later suicide attempts, so suicide risk must still be assessed
Nonsuicidal self-injury is typically used to relieve distress rather than to end life, which distinguishes it from a suicide attempt. However, it is one of the strongest predictors of future suicide attempts, so the counselor assesses suicidal ideation separately rather than relying on the denial alone or assuming the worst.
Question 8 · Psychoticandpersonalitydisorders
For the past five months, a 50-year-old client has been convinced that his neighbor is poisoning his garden to drive him out of the neighborhood. He has no hallucinations, disorganized speech, or negative symptoms, and he continues to work and manage his household well. Which diagnosis is MOST likely?
Answer: D. Delusional disorder, persecutory type
Delusional disorder requires one or more delusions lasting at least one month, without ever meeting Criterion A for schizophrenia, and with functioning not markedly impaired apart from the delusion. Paranoid personality disorder involves pervasive distrust but not a fixed delusion.
Question 9 · Progressandtermination
An agency finds that many clients drop out after one or two sessions. Which strategy is MOST likely to reduce premature termination?
Answer: C. Clarifying expectations about counseling early and gathering routine client feedback
Dropout is reduced by role induction, clarifying expectations about how counseling works and how long it takes, and by routinely collecting client feedback so problems in the alliance or progress are caught early. Lengthening intake tends to increase early dropout rather than reduce it.
Question 10 · Counseling Skills and Interventions
A counselor constructs a three-generation genogram with a family and notes repeated patterns of emotional cutoff and high reactivity across generations. According to Bowen family systems theory, what is the PRIMARY goal of therapy?
Answer: A. To increase each member's differentiation of self
Bowen therapy aims to increase differentiation of self, the ability to separate thinking from feeling and remain emotionally connected without fusing or cutting off. Restructuring hierarchy is the goal of structural therapy, and eliminating symptoms through directives is the goal of strategic therapy.
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