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NBCC 2027 specifications

National Clinical Mental Health Counseling Examination (NCMHCE)

10 case studies, each an intake summary and two sessions, 9 to 15 questions per case with four possible responses, in 225 minutes. The content below is NBCC's own, effective July 1, 2027, and the same for both exams.

156 practice case questions · mock ready (130 questions) · NBCC's specifications (PDF)

Independent preparation. ExamDragon is not affiliated with or endorsed by the National Board for Certified Counselors (NBCC), the Center for Credentialing & Education (CCE) or Pearson VUE. The exams' names are used only to describe the exams; every question, case and guide here is our own, written from NBCC's published 2027 examination specifications.

Domain 1. Professional Development & Counselor Self-Awareness

15% of the exam · our mock: 15 scored · 23 practice

1A. Professional Development

  1. 1A.1Seek consultation from a colleague for assistance with a specific skill or modality
  2. 1A.2Seek supervision from a Counseling supervisor
  3. 1A.3Complete continuing education
  4. 1A.4Develop knowledge of empirically supported Counseling interventions or approaches
  5. 1A.5Engage in advocacy for the client and the Counseling profession
  6. 1A.6Engage in training related to Counseling ethics
  7. 1A.7Engage in training related to ethical and legal use of artificial intelligence (AI)
  8. 1A.8Engage in training related to working with different cultures or populations
Knowledge and skills (NBCC, for guidance)

Knowledge of: Cross-cultural fairness; Continuing education requirements; Levels of advocacy and social justice.

Skill in: Engaging in clinical consultation; Engaging in clinical supervision; Selecting appropriate continuing education resources.

1B. Counselor Self-Awareness

  1. 1B.1Address your compassion fatigue (e.g., burnout) potential
  2. 1B.2Assess your exposure to vicarious trauma
  3. 1B.3Assess your need for specialized training and/or certification
  4. 1B.4Assess your strengths and limitations as a Counselor
  5. 1B.5Assess your suitability to work with a specific client based on their needs and sociocultural considerations
  6. 1B.6Utilize self-regulation techniques
  7. 1B.7Determine the client-Counselor suitability (e.g., Counselor has the skills and experience needed, availability, no conflict of interest)
  8. 1B.8Determine your competency for administering assessments
  9. 1B.9Maintain appropriate boundaries
  10. 1B.10Practice self-care
  11. 1B.11Practice self-reflection
Knowledge and skills (NBCC, for guidance)

Knowledge of: Transference and countertransference within the therapeutic relationship; The importance of self-care; Professional scope and limitations; Power dynamics in the Counseling relationship.

Skill in: Reflexivity/bracketing (e.g., emotional regulation); Recognizing vicarious trauma and burnout; Awareness of your own body language as the Counselor; Self-care strategies; Recognizing the need for professional boundaries; Managing client caseload.

Domain 2. Intake & Assessment

18% of the exam · our mock: 18 scored · 28 practice

2A. Intake

  1. 2A.1Discuss and obtain informed consent/assent from client or guardian
  2. 2A.2Initially evaluate barriers to service
  3. 2A.3Obtain client self-reports
  4. 2A.4Obtain collateral information from other relevant parties (e.g., child and family services, clergy, legal services)
  5. 2A.5Review policies and procedures with client
  6. 2A.6Obtain informed consent appropriate to clientele (e.g., group, family)
  7. 2A.7Obtain informed consent for telemental health services
Knowledge and skills (NBCC, for guidance)

Knowledge of: Barriers to service; Components of informed consent; Client suitability for telemental health services.

Skill in: Discussing informed consent; Explaining policies and procedures; Conducting a clinical/diagnostic interview.

2B. Assessment

  1. 2B.1Assess for trauma
  2. 2B.2Assess risk to self and others
  3. 2B.3Assess substance use
  4. 2B.4Conduct biopsychosocial assessments
  5. 2B.5Conduct mental status examination
  6. 2B.6Determine co-occurring diagnoses, differential diagnoses, and other comorbidities
  7. 2B.7Determine the appropriate level of care
  8. 2B.8Use formal (e.g., assessment results) and informal (e.g., body language) observations
  9. 2B.9Use screening instruments
  10. 2B.10Discuss the results of assessments/instruments with the client
  11. 2B.11Select, administer, and/or interpret appropriate instruments/assessments that align with contextual, cultural, and developmental considerations
  12. 2B.12Use all available data to select the appropriate diagnosis from the most recent DSM/ICD code
Knowledge and skills (NBCC, for guidance)

Knowledge of: Foundational knowledge of statistics; Diagnostic criteria - DSM-5-TR; Diagnostic Criteria - ICD-11; Symptoms of trauma; Medical diagnoses and symptoms that can contribute to mental health symptoms; Differential diagnoses, co-occurring diagnoses, and comorbidities; Risk assessment and risk factors or symptoms; Cultural idioms of distress; Cultural implications of diagnosis.

Skill in: Conducting a diagnostic assessment and evaluation; Conducting and interpreting assessments; Conducting formal assessments; Conducting informal assessments; Conducting lethal means restriction.

Domain 3. Treatment Planning & Continuity of Care

15% of the exam · our mock: 15 scored · 24 practice

3A. Treatment Planning

  1. 3A.1Help client prioritize presenting problems
  2. 3A.2Develop SMART (Specific, Measurable, Attainable, Realistic, and Timely) counseling goals and objectives
  3. 3A.3Develop an initial treatment plan
  4. 3A.4Identify strengths and barriers affecting client goal attainment
  5. 3A.5Integrate assessment results into treatment plans
  6. 3A.6Integrate client’s contextual and cultural considerations into treatment plans
  7. 3A.7Review diagnosis with client
  8. 3A.8Assess for contraindications of treatment approaches
  9. 3A.9Collaborate with client to establish treatment goals and objectives
  10. 3A.10Collaborate with client to revise treatment plan as needed
  11. 3A.11Develop behavioral management plans
Knowledge and skills (NBCC, for guidance)

Knowledge of: SMART goals; Biopsychosocial model; Short- vs. long-term goals; Goals vs. objectives; Counseling theories and interventions; DSM/ICD; Behavioral strategies across settings.

Skill in: Aligning appropriate intervention with client need/identity; Developing initial treatment plan; Reviewing and revising treatment plan; Case conceptualization; Goal-setting; Differential diagnosis.

3B. Continuity of Care

  1. 3B.1Refer clients and/or family members to community resources or to specialists
  2. 3B.2Develop an aftercare plan
  3. 3B.3Discuss with clients how they will maintain progress
  4. 3B.4Develop a discharge plan
  5. 3B.5Develop a relapse prevention plan
  6. 3B.6Develop a plan for disruption of service
  7. 3B.7Engage with client in review of progress toward treatment goals at planned intervals
  8. 3B.8Evaluate treatment effectiveness and client response
  9. 3B.9Collaborate with client to determine counseling termination criteria
Knowledge and skills (NBCC, for guidance)

Knowledge of: Levels of care; Professional wills; Community partner/resources; Release of information (ROI) protocols and requirements; Wraparound services; Stages of change; Discharge practices; Proper termination protocols.

Skill in: Establishing contact with community resources; Applying relapse prevention strategies; Evaluating readiness for discharge.

Domain 4. Provision of Counseling Interventions

20% of the exam · our mock: 20 scored · 31 practice

  1. 4.1Engage in dynamic Couples/Family Counseling
  2. 4.2Explore the impact of the client’s culture, context, values, and worldview
  3. 4.3Facilitate client’s skill development
  4. 4.4Facilitate clients’ ability to navigate interpersonal relationships
  5. 4.5Foster the group therapeutic process
  6. 4.6Implement empirically supported interventions
  7. 4.7Implement interventions aligned with service modality
  8. 4.8Integrate contextual and cultural influences into Counselor-client relationship
  9. 4.9Orient client to the Counseling process
  10. 4.10Provide crisis intervention and de-escalation
  11. 4.11Provide psychoeducation
  12. 4.12Solicit client feedback regarding the Counseling process
  13. 4.13Support client in advocating for their needs
  14. 4.14Use core Counseling skills to facilitate treatment
  15. 4.15Monitor and resolve therapeutic ruptures
Knowledge and skills (NBCC, for guidance)

Knowledge of: Substance use disorder interventions; Core conditions; Client suitability; Multicultural and Social Justice Counseling Competencies; Core Counselor/Counseling attributes; Formative and summative feedback; Counseling theories and strategies; Counseling modalities.

Skill in: Addressing inappropriate client behavior during the session; Reading nonverbal cues; Active listening; Open-ended questioning; Reflecting skills; Summarizing; Reframing; Paraphrasing; Closed-ended questioning; Establishing therapeutic alliance/rapport; Broaching; Tailoring culturally responsive interventions; Self-disclosure; Immediacy; Applying theories appropriately; Providing psychoeducation; Perspective taking; Use of confrontation; Use of silence; Giving feedback; Crisis intervention; Repairing and resolving client rupture; Establish and maintain professional boundaries; Session management (time management); Communicating with clients; Maintaining confidentiality; Linking; Blocking; Facilitating here and now awareness; Modeling; Core counselor attributes (Empathy; Unconditional positive regard; Authenticity; Genuineness; Congruence).

Domain 5. Indirect Client Care

12% of the exam · our mock: 12 scored · 19 practice

  1. 5.1Collaborate with client’s relevant support systems (e.g., advocate, family, wraparound services, legal services) with goals and objectives
  2. 5.2Collaborate with non-clinical stakeholders (e.g., legal counselor, community resources)
  3. 5.3Collaborate with other treatment providers (e.g., care coordination, interdisciplinary treatment team)
  4. 5.4Document the self-reported effects of client’s medication
  5. 5.5Maintain an updated list of referral resources
  6. 5.6Review clinical documentation before client sessions
  7. 5.7Secure appropriate translation services for clients’ preferred language
  8. 5.8Write clinical documentation during or after client sessions
Knowledge and skills (NBCC, for guidance)

Knowledge of: Documentation practices and models; Release of information and confidentiality; Basic psychopharmacological information; Professional roles; Record retention and management.

Skill in: Completing case notes; Case conceptualization; Advocating for client.

Domain 6. Legal & Ethical Compliance

20% of the exam · our mock: 20 scored · 31 practice

  1. 6.1Activate (i.e., follow) an emergency preparedness plan for your Counseling practice in response to a relevant incident
  2. 6.2Adhere to internal policies or standard operating procedures (SOPs) relevant to your clinical practice (e.g., informed consent, record retention, release of information, mandated reporting protocols)
  3. 6.3Adhere to relevant state and federal laws and regulations that apply to your clinical practice
  4. 6.4Adhere to telemental health best practice guidelines
  5. 6.5Adhere to the Counseling codes of ethics
  6. 6.6Engage in activities to maintain licensure status
  7. 6.7Engage in billing, third-party reimbursement and other insurance panel processes
  8. 6.8Engage in compliance-related training (e.g., insurance, credentialing, billing, payment)
  9. 6.9Ensure telemental health platforms are utilized in compliance with state and federal laws
  10. 6.10Ensure that reimbursement requests are supported by proper clinical documentation
  11. 6.11Implement technology-assisted clinical tools (e.g., online therapy platform, AI note takers, virtual reality tools, calming apps, wearable devices to monitor heart rate and breathing)
  12. 6.12Maintain professional liability insurance
  13. 6.13Practice in accordance with license portability (e.g., Counseling Compact)
  14. 6.14Provide adequate accommodations for clients with disabilities
  15. 6.15Review and update an emergency preparedness plan for your Counseling practice
  16. 6.16Securely maintain case notes, records, and files
  17. 6.17Solicit best practices for understanding and adhering to obligations of court proceedings
  18. 6.18Use an electronic health record (EHR) or electronic medical record (EMR) system
  19. 6.19Use artificial intelligence (AI) within your Counseling practice
  20. 6.20Market your Counseling business appropriately (e.g., proper utilization of social media, proper protection of client information)
Knowledge and skills (NBCC, for guidance)

Knowledge of: State laws (state licensure law, supervision requirements, abuse reporting, license renewal, CAQH); Federal laws (e.g., HIPAA, FERPA, immigration policy, HI-TECH, ADA, NPI); Codes of ethics; Third-party reimbursement, insurance and billing (e.g., CPT codes); Counseling Compact; Emerging technologies in Counseling; Crisis policies and procedures; Recording keeping and reporting requirements and procedures; Appropriate logistics for telemental health services; Scope of practice (e.g., letters of support, working with special populations); Alternative medical-assisted/pharmacological interventions; Accessing state licensure board; Executing voluntary and involuntary commitments.

Skill in: Maintaining confidentiality; Discerning reputable training providers and programs; Troubleshooting technological difficulties during telemental health session (e.g., session disconnects, video not working); Billing and third-party reimbursement.

NBCC, National Counselor Examination (NCE) Examination Specifications and National Clinical Mental Health Counseling Examination (NCMHCE) Examination Specifications, both "Effective July 1, 2027", "Copyright © 2026": Table 1 (domain weighting) and Table 2 (work tasks, knowledge and skills), identical in both documents (docs/nce/SOURCES.md N1, N2).