The NBCC Creed

National Clinical Mental Health Counseling Examination

About the NCMHCE

The National Clinical Mental Health Counseling Examination (NCMHCE) is designed to assess the knowledge, skills, and abilities determined to be important for providing effective counseling services. The NCMHCE is a requirement for counselor licensure in many states. It is one of two examination options for the National Certified Counselor (NCC) certification and also fulfills the examination requirement for the Certified Clinical Mental Health Counselor (CCMHC) specialty certification.

NCMHCE Content Outline

Options for Examination Delivery

You can take the examination as part of either the National Certified Counselor (NCC) or Certified Clinical Mental Health Counselor (CCMHC) application, which will be covered in this handbook. The benefit of taking the examination via this method is that it allows you to get a head start on earning your professional credentials.

You can take the examination on its own, as part of the state licensure process. For more information on this process, review the state licensure candidate handbook.

Prepare for the NCMHCE

Study guides are available to help you prepare for the NCMHCE.


Download a Special Request Form

Forms are available for download if special accomomodations are needed for the NCMHCE.

Special Examination Accommodation Request Form for NBCC/CCE Certification and Credentialing Candidates Special Examination Accommodation Request Form for State Licensure Candidates

Content and Development

The development of the NCMHCE in the early 1990s marked the expansion of counseling national certification into the evaluation of counselors’ ability to apply core knowledge to clinical practice.

The American Mental Health Counselors Association (AMHCA) initially developed the Certified Clinical Mental Health Counselor (CCMHC). After several years of administration of the credential, it was determined that the credential could be strengthened and expanded by adding a national, standardized examination. NBCC agreed to acquire the credential in the early 1990s and develop an examination to anchor the certification and align the application process with the profession’s foundational national certification, the National Certified Counselor (NCC).

NBCC developed the NCMHCE with a focus on drawing from the common core knowledge of professional counselors. A committee of subject matter experts (SMEs) led by psychometric experts framed the NCMHCE to ensure that it reflected the central clinical requirements of counselors through real-world simulated cases.

The NCMHCE measures an individual’s ability to apply and evaluate knowledge in core counselor skills and competencies and to practice competently as a professional counselor. Specifically, it assesses an entry-level clinical mental health counselor’s ability to apply knowledge of theoretical and skill-based tenets to clinical case studies. The case studies are designed to capture a candidate’s ability to identify, analyze, diagnose, and develop plans for treatment of clinical concerns.

Candidates for the NCMHCE must have a graduate-level degree or higher from a counseling program accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) or administered by an institutionally accredited college or university. The counseling degree program must contain courses in nine requirement areas.

The Nine CACREP Curriculum Educational Standards:

  1. Human Growth and Development
  2. Social and Cultural Foundations in Counseling
  3. Helping Relationships in Counseling
  4. Group Counseling and Group Work
  5. Career Counseling and Lifestyle Development
  6. Assessment in Counseling
  7. Research and Program Evaluation
  8. Professional Orientation to Counseling
  9. Counseling Field Experience

Six Defined Work Behaviors (Domains)

The table below reflects the item distribution among these six defined work behaviors (domains), which are further described below. A thorough delineation of each domain and subdomain is available in the NCMHCE Content Outline and NCMHCE Handbook.

Table 1.The weight for each domain

Domain Percent of Items
1 Professional Practice and Ethics 10-20
2 Intake, Assessment, and Diagnosis 20-30
3 Areas of Clinical Focus 0*
4 Treatment Planning 10-20
5 Counseling Skills and Interventions 25-35
6 Core Counseling Attributes 10-20

The domain “Areas of Clinical Focus” represents the diagnoses and main presenting problems that were identified in the job analysis as being the most prevalent in clinical work. This domain is evaluated through a variety of diagnoses and case scenarios appearing on each examination form and not at the item level. Please check the sample case studies tab for more information about the weight of each domain.


  • Professional Practice and Ethics assesses counselors’ knowledge, skills, and abilities as they pertain to maintaining proper administrative and clinical protocols. This includes topics such as informed consent, client records, use of social media, and confidentiality.
  • Intake, Assessment, and Diagnosis consists of items designed to assess a counselor’s knowledge, skills, and abilities to conduct client intake, assessment, and diagnosis. Items in this domain may reflect content such as performance of Mental Status Exams (MSEs), assessment for substance use, and evaluation of an individual’s level of mental health functioning.
  • Areas of Clinical Focus is one of the largest domains on the exam, accounting for more than 25% of the scored items. This section allows for the assessment of a counselor’s knowledge and skills related to a broad range of potential client concerns. For example, items may be related to bullying, obsessive thoughts/behaviors, sleeping habits, adoption issues, divorce, etc.
  • Treatment Planning is the domain of the exam that is built to assess a counselor’s knowledge, skills, and abilities as they relate to effectively treating clients. This domain houses items that may cover everything from a counselor’s ability to identify barriers to client goal attainment, discussing termination, follow-up after discharge, revisions of the treatment plan, or collaboration with other providers.
  • Counseling Skills and Interventions is the largest domain on the NCE exam, accounting for over 25% of the scored items. This domain encompasses items written to assess counselors’ knowledge, skills, and abilities to conduct effective counseling. This is a broad and comprehensive domain that covers topics such as establishment of a therapeutic alliance, providing crisis intervention, use of self-disclosure, exploring the influence of family, and identifying group themes.
  • Core Counseling Attributes is the smallest domain of the NCE, and it assesses the behavior, traits, and dispositions of effective counselors. This domain is measured with items that address topics such as genuineness, empathetic responding, positive regard, and respect for and acceptance of diversity.

The NCMHCE includes 11 case studies. Of the total number of multiple-choice questions, 100 will be scored, and one of the case studies will be unscored. The unscored narrative and questions are used to generate statistics for future examinations. Each case study will comprise one narrative and 9–15 multiple-choice questions.

Sample Case Studies for the NCMHCE

The NCMHCE case studies are designed to replicate the actual work of clinical mental health counselors. Each case study will comprise one narrative and 9–15 multiple-choice questions.

View Sample Case Studies

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