What is the counselor's FIRST priority in this session?

Conduct a structured suicide risk assessment of the passive ideation she disclosed

Which piece of Marisol's history most strongly warrants a medical referral before finalizing a diagnosis?

Untreated hypothyroidism with missed levothyroxine refills

Which assessment instrument is MOST appropriate to administer at this intake?

PHQ-9 with the Columbia Suicide Severity Rating Scale

Assuming medical causes are ruled out, which diagnosis is BEST supported?

Major Depressive Disorder, single episode, moderate

Her belief that feeling relief 'proves I'm a terrible daughter' is BEST conceptualized as:

A cognitive distortion — specifically, emotional reasoning and labeling

Which treatment goal is written in the MOST measurable, appropriate form for the initial plan?

Client will reduce PHQ-9 score from 17 to below 10 within 12 weeks

Marisol's faith and her family's expectation that she 'should be over it' should be addressed by:

Integrating her faith as a documented protective factor and exploring family expectations as a stressor

Which intervention is the highest priority in the first four sessions?

Behavioral activation paired with sleep-hygiene intervention

Marisol's sister calls the clinic asking how Marisol is doing. No release is on file. The counselor should:

Neither confirm nor deny that Marisol is a client

At session six Marisol says, 'I don't think you can really understand this unless you've lost your mother.' The MOST therapeutic response is:

'You're right that I haven't lived it. Help me understand what it's been like for you.'

Are free NCMHCE practice questions realistic?

Most free NCMHCE questions online are multiple-choice recall items, which do not match the exam. The real NCMHCE presents 11 clinical case simulations requiring sequenced decisions. A realistic free practice exam must use a full case vignette with decision-point questions, as this one does.

How many practice cases should you complete before the NCMHCE?

Most candidates need 20 to 40 full case simulations before performance stabilizes. One free case shows you the format; consistent accuracy across many varied cases is what predicts passing.

Free practice

Free NCMHCE practice exam

Q: Is there a free NCMHCE practice exam?

Yes. This page provides a free NCMHCE practice exam: a complete clinical case simulation with 10 scored questions and full rationales, in the same format the NBCC uses. No signup or email is required.

What this is

One complete NCMHCE clinical case simulation with 10 scored questions and full rationales, written in the exact NBCC format — a long case vignette followed by sequenced clinical decisions. No signup, no email, no paywall on this page.

Case simulation: Marisol R., 34

Marisol Reyes is a 34-year-old bilingual (Spanish/English) elementary school teacher who self-refers to your outpatient community mental health clinic. She arrives on time, dressed neatly, and makes limited eye contact during the first ten minutes of the intake.

She reports that for the past four months she has felt "switched off." She describes waking at 3:00 a.m. most nights and being unable to return to sleep, a 12-pound unintentional weight loss, and difficulty concentrating well enough to write lesson plans. She has called out of work six times in the past two months, which she says is "not like me at all — I haven't missed a day in nine years."

The onset coincides with the death of her mother, who lived with Marisol and her husband for the final eighteen months of a pancreatic cancer illness. Marisol was the primary caregiver. She says she feels "guilty for being relieved" that the caregiving is over, and that this thought "proves I'm a terrible daughter."

Marisol denies current suicidal ideation but volunteers, without prompting, that "sometimes I think everyone would be fine if I just didn't wake up." She has no plan, no means identified, and no history of attempts. She has never been in counseling before and has never taken psychiatric medication.

Medical history: hypothyroidism, diagnosed three years ago, managed with levothyroxine. She reports she "probably" missed refills during her mother's final weeks and has not seen her primary care physician in over a year. She drinks one glass of wine most evenings, up from one or two per week before her mother's illness. No other substance use.

Family and cultural context: Marisol is the eldest of four siblings in a close Mexican-American family. She describes strong expectations that she manage family matters. Her husband is supportive but works nights. Her siblings have told her she "should be over it by now." She attends Mass weekly and describes her faith as "the only thing holding me together."

Mental status: alert and oriented ×4; speech slowed with increased latency; affect constricted and congruent with depressed mood; thought process linear; no hallucinations, delusions, or homicidal ideation; insight fair; judgment intact.

The 10 questions

Answer all ten, then score yourself. On the real exam you cannot go back to a prior section — try to work in order without skipping.

Intake and initial decision-making
1. What is the counselor's FIRST priority in this session?
Intake and initial decision-making
2. Which piece of Marisol's history most strongly warrants a medical referral before finalizing a diagnosis?
Assessment and diagnosis
3. Which assessment instrument is MOST appropriate to administer at this intake?
Assessment and diagnosis
4. Assuming medical causes are ruled out, which diagnosis is BEST supported?
Assessment and diagnosis
5. Her belief that feeling relief 'proves I'm a terrible daughter' is BEST conceptualized as:
Treatment planning
6. Which treatment goal is written in the MOST measurable, appropriate form for the initial plan?
Treatment planning
7. Marisol's faith and her family's expectation that she 'should be over it' should be addressed by:
Counseling skills and interventions
8. Which intervention is the highest priority in the first four sessions?
Professional practice and ethics
9. Marisol's sister calls the clinic asking how Marisol is doing. No release is on file. The counselor should:
Core counseling attributes
10. At session six Marisol says, 'I don't think you can really understand this unless you've lost your mother.' The MOST therapeutic response is:

0 of 10 answered

Why most free NCMHCE practice questions don't help

Search "free NCMHCE practice questions" and you'll mostly find standalone multiple-choice recall items — "which neurotransmitter is implicated in…". The NCMHCE does not test that way. It gives you 11 long clinical cases and asks you to make sequenced decisions where the right answer depends on what you already chose. Practicing recall items builds a skill the exam never measures.

The case above is the correct shape. The problem with any free resource is volume: one case teaches format, twenty to forty varied cases is what actually moves your accuracy.

What to do after this case

Read every rationale, including for questions you got right — the reasoning matters more than the score.
Note which of the five NBCC domains you missed items in; that's your study target, not "depression" or "ethics" generally.
Move to timed, full-length practice. See the 8-week plan.

Unlimited cases, not just this one

$100 one-time, lifetime access. Every case is AI-generated fresh, so you never repeat one, and the readiness dashboard tracks accuracy across all five NBCC domains. If our dashboard says you're Exam Ready and you don't pass, email annie@emdrassist.com with your Exam Ready screenshot and failed score (with dates) for a full refund.

Take the 5-min readiness quiz