Clinical counseling licensure · checked Oct 30, 2026
NCMHCE exam: how the clinical case exam works
National Clinical Mental Health Counseling Examination
The National Clinical Mental Health Counseling Examination is 11 clinical case studies with 130–150 multiple-choice questions. Every case opens with the client's provisional diagnosis, and the questions ask what a licensed counselor would do with it: confirm or question it, check for risk, plan treatment and choose the next step in session. This page covers the format, the five scored domains, the states that require it and the switch to a new form in 2027.
Updated Oct 30, 2026 · Not affiliated with NBCC, CCE, AMFTRB, CRCC, ACA or AAMFT.
on the current form11 cases
exam time225 min
exam fee in Virginia, Oct 2026$275
the 2027 form10 cases, pass at 360
Exam facts
Fact
Detail
Source
Checked
Exam owner
National Board for Certified Counselors (NBCC)For state licensure the exam is administered by NBCC's affiliate, the Center for Credentialing & Education (CCE), and delivered by Pearson VUE.
NBCC: National Clinical Mental Health Counseling Examination (NCMHCE) · NBCC: NCMHCE Candidate Handbook for State Licensure, rev. Nov 20, 2025 (PDF) [1][2]
Leads to
Clinical counselor licensure (LMHC, LPCC, LCPC and similar titles), the NCC and the CCMHCSome states use it for the only counseling license, others for the clinical tier after the NCE.
NBCC: National Clinical Mental Health Counseling Examination (NCMHCE) · NBCC: NCMHCE Candidate Handbook for National Certification, rev. Oct 16, 2025 (PDF) · NBCC: National Certified Counselor (NCC) [1][3][4]
Question format
Case studies: an intake summary and two counseling sessions, each followed by multiple-choice questionsSince 2022 there are no simulations, no information-gathering sections and no negative marking; the provisional diagnosis is given in the case.
NBCC: NCMHCE Candidate Handbook for State Licensure, rev. Nov 20, 2025 (PDF) · NBCC: NCMHCE old vs new format chart (PDF) [2][5]
Scored questions
100 scored questions; one case and some questions are unscored
NBCC: NCMHCE Candidate Handbook for State Licensure, rev. Nov 20, 2025 (PDF) [2]
Exam time
3 hours 45 minutes (225 minutes)
NBCC: NCMHCE Candidate Handbook for State Licensure, rev. Nov 20, 2025 (PDF) [2]
Where you test
Pearson VUE test center or OnVUE online proctoringOnly specific, limited accommodations are available on OnVUE.
NBCC: NCMHCE Candidate Handbook for State Licensure, rev. Nov 20, 2025 (PDF) [2]
Passing score
A raw cut score for each exam form, out of 100 scored points, set by an expert panel and then equatedThe cut varies slightly from form to form and is not a percentage. From July 1, 2027: a scaled score of 100–500 with 360 to pass on every form; the 2027 specifications name an Angoff standard-setting study.
NBCC: NCMHCE Candidate Handbook for State Licensure, rev. Nov 20, 2025 (PDF) · NBCC: NCMHCE Content Outline, rev. Oct 8, 2025 (PDF) · NBCC: NCMHCE Examination Specifications, effective July 1, 2027 (PDF) [2][6][7]
Exam fee
$275Paid to NBCC/CCE, not to the state; the NBCC handbook does not print the fee. The Virginia board lists $275; the Florida board lists $350 for a first attempt and $275 for a retake; older NBCC state forms showed other amounts, so check your board. Through the NCC or CCMHC route the exam is included in the $375 application.as of Oct 30, 2026 · Virginia board figure; Florida lists $350 for a first attempt
Virginia Board of Counseling: examination information · Florida Board 491: Licensed Mental Health Counselor · NBCC: NCMHCE Candidate Handbook for State Licensure, rev. Nov 20, 2025 (PDF) [2][8][9]
Changes in 2027
From July 1, 2027: 10 cases instead of 11, a 100–500 scale with 360 to pass, and a new 6-domain outline shared with the NCECandidates who test before the switch take the current form; NBCC plans no overlap period.
NBCC: NCMHCE Examination Specifications, effective July 1, 2027 (PDF) · NBCC: National Clinical Mental Health Counseling Examination (NCMHCE) [1][7]
iFacts checked Oct 30, 2026 against the testing organizations; sources are listed under Source notes. Registration, timing, results and retakes, each with its source: NCMHCE exam facts.
Anatomy of a case
NBCC's sample case in the state-licensure handbook (Appendix B) shows the layout every case follows:
Header
Age, gender, ethnicity, relationship status, the setting (agency, private practice, college center), the type of counseling and a provisional diagnosis with its ICD-10-CM code.
Intake summary
The presenting problem, history, observations and the client's own words. The first block of questions follows it.
First later session
New information arrives: test scores, a crisis, a family member's call. Questions now assume what the session revealed.
Second later session
Progress, setbacks, termination or a change of plan. The last questions often test whether the plan or the diagnosis should change.
Because the diagnosis is handed to you, the diagnostic questions in NBCC's sample case ask why it fits: which detail meets a criterion, which specifier applies, what else to rule out. Read each question against what the case has revealed so far, not against what you expect later. Wrong answers cost nothing beyond the missed point, so leave none blank.
Five scored domains
Weights from the content outline NBCC revised in October 2025. A sixth domain, Areas of Clinical Focus, has no questions of its own: NBCC tests it through the diagnoses and concerns built into the cases (the list).
The switch comes on July 1, 2027: one case fewer, a scaled score, a new outline, each listed among the exam facts. If your appointment falls before that date, you take today's form; there is no period when both versions run.
The 2027 outline is the same one the NCE moves to, so the two exams will share domain names and weights while keeping different formats: cases here, single questions there. Domains, scoring and new topics side by side: the 2027 form.
Where the NCMHCE is required
Our state cards (checked against board pages and NBCC's licensure directory, Oct 2026) sort the 50 states and DC like this:
The only accepted exam in 8 states: California (LPCC), Florida, Massachusetts, Nevada, New Hampshire, New York, Rhode Island and Utah. In Florida, Massachusetts, New York and Rhode Island the license is the LMHC, which is why people search for an "LMHC exam".
The second step in 11 states: the first license usually comes with the NCE, the clinical one with this exam (in Illinois it is one of two routes to the LCPC). Which states, side by side with the NCE: NCE vs NCMHCE.
Either exam in 21 states, Ohio among them since January 2026; West Virginia lists both.
Today's cut is set per form: a raw score out of the scored questions, adjusted for each form's difficulty. The 360 you see quoted belongs to the 2027 scale. Details: passing score.
Try a short case
Question 1 of 5 · Core Counseling Attributes · 15%
A client says angrily that therapy isn't getting anywhere and it's your fault. Which response best demonstrates nondefensive listening?
Telling the client that therapy takes time is reassurance that dismisses the complaint instead of exploring what feels stuck.
Reading the anger as transference from other authority figures is a premature interpretation that deflects legitimate feedback about the therapy itself.
Pointing to progress the client supposedly cannot see defends the counselor's work; the "but" cancels the empathy and tells the client the complaint is wrong.
Thanking the client and inviting a joint look at what isn't working treats the criticism as useful feedback, which is how a rupture is repaired and the alliance strengthened.
Question 2 of 5 · Core Counseling Attributes · 15%
A client finally admits she has hidden a large gambling debt from her husband. Why is positive regard especially important at this moment?
Unconditional positive regard means accepting her as a person, so she can keep exploring a shameful secret without fearing that you will reject her.
Positive regard accepts the person, not the behavior; reading it as approval of how she handled the debt is the classic misunderstanding of Rogers' condition.
Acceptance does not rule out later exploring or gently challenging the secrecy; positive regard is the base that makes such a challenge tolerable.
Positive regard is not a tool for getting her to follow advice; this confuses a relationship condition with directive persuasion.
Case 1Intake · questions 3–5
Intake
Age: 47 · Gender: Female · Sexuality: Heterosexual Ethnicity: Puerto Rican · Relationship status: Divorced Setting: Community mental health agency · Counseling: Individual Provisional diagnosis: Major depressive disorder, recurrent episode, moderate: F33.1
You are a licensed counselor at a community mental health agency. Maribel, 47, supervises a hospital billing office. For 5 weeks she has felt low most of the day and lost interest in the salsa class she loved. She wakes at 4 a.m., eats little, feels tired and guilty, and has trouble concentrating at work. She had a similar episode at 35, after her divorce, which improved with counseling. She also has hot flashes and night sweats and is waiting for a gynecology appointment. Her PHQ-9 score is 16. She denies suicidal ideation and says, "My faith and my daughter keep me going."
Case 1 · Question 1 of 3 · Intake, Assessment, and Diagnosis · 25%
Which information supports the specifier "recurrent episode"?
A separate earlier episode, with at least 2 months between episodes, is what makes the current one recurrent.
Five weeks of symptoms meets the 2-week minimum for an episode but says nothing about recurrence.
A PHQ-9 of 16 reflects severity, not the number of episodes.
Hot flashes and night sweats point to perimenopause, which matters for the medical review but does not define recurrence.
Case 1 · Question 2 of 3 · Treatment Planning · 15%
Which coordination step is most important in her plan?
Attributing her mood to menopause alone overlooks a recurrent depressive disorder.
Perimenopausal changes can affect mood and sleep, so sharing findings with her gynecologist lets medical factors be reviewed alongside counseling.
Delaying counseling until hormone tests are back, even with her consent, leaves a moderate depressive episode untreated.
Working without medical contact misses factors that may contribute to her symptoms.
Case 1 · Question 3 of 3 · Counseling Skills and Interventions · 30%
Which intervention best targets her loss of interest?
Waiting for interest to return reverses the process: activity tends to come before mood improves.
Exploring early losses does not target her current withdrawal from activities.
Behavioral activation schedules small, valued activities, which rebuilds reward and mood in depression.
More rest tends to deepen inactivity and low mood.
Answer every question to see your score
Related pages
NCMHCE practice testFour full clinical cases in the current format plus single items, every option explained
NCMHCE exam factsRegistration routes, Pearson VUE and OnVUE, timing, results, retakes and the 2027 form
NCMHCE costExam fee, the NCC/CCMHC route, rescheduling, retakes and the board fees around them
NCMHCE passing scoreThe per-form raw cut today, the scaled cut from 2027 and the only published pass rates
NCMHCE study guideSix-week plan by domain weight, how to read a case, the DSM-5-TR minimum
No. The case header gives a provisional diagnosis with its code. Questions ask you to support it, add a specifier, spot a co-occurring condition or decide whether new information changes it.
How many of the cases count?
All but one: one case and some individual questions are unscored, and you cannot tell which. Treat every case as scored.
Can I sit the exam from home?
Yes. Besides Pearson VUE centers, NBCC offers the exam through OnVUE online proctoring. Fewer accommodations are available online, so request them before you pick the format.
Do I need the NCE first?
Only in the states that license in two steps. In 11 states the NCE comes first and this exam unlocks the clinical license (in Illinois, one of two routes to the LCPC); in 8 states this is the only exam accepted; in 21 states either one works.