National Counselor Examination (NCE) — All Questions

Three years after counseling ended, a former client contacts her counselor and asks him out on a date. Under the ACA Code of Ethics (2014), what applies?

• a.A romantic relationship is permitted once a colleague has approved it
• b.A romantic relationship is permitted because more than 2 years have passed
• c.A romantic relationship is permitted because the former client initiated it
• d.It is prohibited for 5 years after the last professional contact✓

ACA Code A.5.c prohibits sexual and/or romantic relationships with former clients for 5 years following the last professional contact, and even after 5 years the counselor must document forethought about possible exploitation or harm. A 2-year rule does not appear in the ACA Code. Who initiates the contact and a colleague's approval do not lift the prohibition.

A counselor learns that a colleague routinely arrives late to sessions and keeps sloppy notes. No client has been substantially harmed. According to the ACA Code of Ethics, what should the counselor do first?

• a.Take no action until a client is harmed
• b.File a complaint with the state licensing board before speaking to the colleague
• c.Attempt to resolve the concern informally with the colleague✓
• d.Inform the colleague's clients of the problem

ACA Code I.2.a directs counselors who believe a colleague is violating a standard, when substantial harm has not occurred, to first attempt informal resolution with that counselor if feasible and confidentiality allows. A board complaint is the route when harm is substantial or informal resolution fails. Telling the colleague's clients would breach their confidentiality, and waiting for harm ignores the duty in I.2.a. NBCC Code directive 10 likewise calls for reasonable resolution first unless state rules require immediate reporting.

Which condition is required before a counselor may barter under ACA Code standard A.10.e?

• a.The client requests the arrangement✓
• b.The goods offered exceed the value of the usual fee
• c.The terms are kept verbal to protect the client's privacy
• d.The counselor proposes it when fees fall behind

ACA Code A.10.e allows bartering only if it does not result in exploitation or harm, if the client requests it, and if it is an accepted practice among professionals in the community; the agreement is documented in a clear written contract. A counselor-initiated barter to recover fees fails the client-request condition. Keeping terms verbal contradicts the written-contract requirement, and an exchange worth more than the fee invites exploitation.

A client is court-mandated to attend anger management counseling, and the court expects attendance reports. What does the ACA Code require the counselor to do?

• a.Send attendance reports to the court without telling the client
• b.Share session content with the court only if the client fails
• c.Explain in advance what will be shared, and with whom✓
• d.Refuse the referral because mandated clients cannot consent

ACA Code A.2.e requires counselors to discuss the limits of confidentiality with mandated clients and explain what type of information will be shared, and with whom, before counseling begins; the client may refuse services, and the counselor then discusses the consequences of refusing. Reporting without telling the client violates this. Mandated clients are not barred from services, and disclosure terms must be set at the outset rather than decided later.

A counselor licensed in one state wants to provide video counseling to a client who lives in another state. According to the ACA Code of Ethics, whose laws may the counselor be subject to?

• a.Only federal law, because interstate practice is federally governed
• b.Both the counselor's location and the client's residence✓
• c.Only the laws of the state where the counselor is licensed
• d.Only the laws of the state where the video platform is based

ACA Code H.1.b states that counselors using distance counseling may be subject to the laws and regulations of both the counselor's practicing location and the client's place of residence, and must inform clients of pertinent legal rights and limitations across state lines. Neither the counselor's state alone nor the platform's location settles the question, and interstate counseling is not governed by federal law alone.

A competent adult client asks for a copy of her counseling records. Under the ACA Code of Ethics, when may the counselor limit her access?

• a.Whenever the records contain the counselor's private clinical impressions and hypotheses
• b.Whenever the client has an unpaid balance for services
• c.Whenever the counselor believes the client may misread them
• d.Only when there is compelling evidence that access would harm the client✓

ACA Code B.6.e requires counselors to provide reasonable access to records for competent clients and to limit access only when there is compelling evidence that access would cause harm; the request and the rationale for any withholding are documented. Clinical impressions, an unpaid balance, or a general worry that the client may misunderstand do not meet that standard, and B.6.f expects counselors to help clients interpret records.

A client discloses a communicable, life-threatening disease and says he has not told his partner. Under ACA Code B.2.c, what should the counselor do before any disclosure to the partner?

• a.Keep the information confidential in all circumstances
• b.Notify the partner right away, without first discussing the matter with the client
• c.Notify the local health department before the next session
• d.Assess whether the client intends to inform the partner and follow state law✓

ACA Code B.2.c says counselors may be justified in disclosing to identifiable third parties at serious and foreseeable risk, but before disclosing they assess the client's intent to inform those parties or engage in harmful behavior, and they adhere to relevant state laws on disclosing disease status. Immediate notification skips the required assessment, absolute confidentiality ignores the permitted exception, and a health-department report is a matter of state law rather than a step the Code prescribes.

A counselor who works at a community agency also has a small private practice. An agency client asks to continue with the counselor privately. The agency has no policy on self-referral. What does the ACA Code direct?

• a.The counselor does not refer the client to the private practice✓
• b.The counselor may accept if the client initiated the request
• c.The counselor may accept if the client pays the agency rate
• d.The counselor may accept the client after the agency case closes

ACA Code A.10.a states that counselors working in an organization do not refer clients to their private practice unless the organization's policies make explicit provisions for self-referral, and in that case clients must be told of other options. With no such policy, closing the agency case, matching fees, or the client's initiative does not make the referral permissible.

Under the NBCC Code of Ethics (2023), a counselor accepts a small handmade gift from a client because it is culturally meaningful. What must the counselor also do?

• a.Report the gift to NBCC within 30 days
• b.Pay the client the gift's market value
• c.Return the gift after counseling ends
• d.Document it in the client's record✓

NBCC Code directive 21 permits accepting gifts only when culturally appropriate or therapeutically relevant, requires the counselor to consider the gift's value and its effect on the relationship, and states that acceptance of a gift shall be documented in the client's record. The Code does not require paying for the gift, reporting it to NBCC, or returning it later.

A researcher concludes that a new group intervention reduces anxiety, but in the population it actually has no effect. What kind of error has occurred?

• a.Regression toward the mean
• b.Type I error✓
• c.Sampling bias only
• d.Type II error

A Type I error is rejecting a null hypothesis that is true: claiming an effect that does not exist; its probability is set by alpha. A Type II error is the opposite, failing to detect an effect that does exist. Sampling bias and regression toward the mean are possible causes of misleading results, but the name for concluding an effect exists when it does not is a Type I error.

A counselor randomly assigns clients to either CBT or a waitlist and compares their anxiety scores after 8 weeks. In this study, the assignment to CBT or waitlist is the:

• a.dependent variable
• b.confounding variable
• c.independent variable✓
• d.intervening variable

The independent variable is the factor the researcher manipulates, here the treatment condition. The dependent variable is the outcome measured, the anxiety scores. A confounding variable is an uncontrolled factor that varies with the treatment and distorts the result, and an intervening variable is a presumed mechanism between cause and effect; neither is the condition the researcher manipulates.

A current client sends her counselor a friend request on a personal social media account. According to the NBCC Code of Ethics (2023), how should the counselor respond?

• a.Accept after termination, as social media rules end with counseling
• b.Decline, since connecting with clients online is to be avoided✓
• c.Accept, provided the account has strict privacy settings
• d.Accept, as long as the counselor never comments on the client's posts

NBCC Code directive 114 requires counselors to avoid non-professional relationships with clients online, including connecting with or following client social media accounts, and ACA Code A.5.e prohibits personal virtual relationships with current clients. Privacy settings or silence on the platform do not change the relationship, and directive 109 requires a social media policy that covers former clients as well as current ones.

During a mental status exam, a client says her mood is "fine" while tears run down her face. How should the counselor describe this in the MSE?

• a.Mood and affect are incongruent✓
• b.Thought content is delusional
• c.Perceptual disturbance is present
• d.Insight is intact and mood is euthymic

In the MSE, mood is what the client subjectively reports and affect is the emotion others can observe; a mismatch between them is noteworthy and is recorded as incongruence. Nothing in the scenario suggests a fixed false belief (thought content) or hallucinations (perception), and calling mood euthymic would ignore the visible distress.

A counselor asks a client what the saying "People in glass houses shouldn't throw stones" means. The client says, "Glass breaks easily." This response most directly suggests difficulty with:

• a.attention span
• b.long-term memory recall
• c.orientation
• d.abstract thinking✓

Proverb interpretation assesses abstract thinking; a literal, concrete answer suggests the client does not grasp the larger meaning. Long-term memory is assessed through past life events, attention through tasks such as simple calculations, and orientation through awareness of person, place, and time.

A client earns a T-score of 60 on a normally distributed scale (mean 50, SD 10). Approximately what percentile is this?

• a.60th
• b.84th✓
• c.98th
• d.70th

A T-score of 60 is one standard deviation above the mean (z = (60 - 50) / 10 = +1). In a normal distribution about 50% of scores fall below the mean and about 34% fall between the mean and +1 SD, so 50 + 34 = about the 84th percentile. The 98th percentile corresponds to about +2 SD, and 60th or 70th confuses the raw T value with a percentile.

On an intelligence test with a mean of 100 and a standard deviation of 15, a client scores 70. Approximately what percentile is this score?

• a.70th
• b.16th
• c.2nd✓
• d.30th

A score of 70 is two standard deviations below the mean (z = (70 - 100) / 15 = -2). About 2.3% of a normal distribution falls below -2 SD, so the score is near the 2nd percentile. The 16th percentile corresponds to -1 SD (a score of 85), and 30th or 70th treats the score itself as a percentile.

A counselor gives the same anxiety inventory to a group twice, two weeks apart, and correlates the two sets of scores. What is being estimated?

• a.Predictive validity
• b.Internal consistency reliability
• c.Test-retest reliability✓
• d.Interrater reliability

Correlating scores from two administrations of the same test to the same people over time estimates test-retest reliability, or stability. Internal consistency comes from a single administration (for example, coefficient alpha). Predictive validity correlates scores with a later criterion, and interrater reliability compares different scorers.

An employer correlates applicants' scores on a screening test with their job performance ratings one year later. This study provides evidence of:

• a.face validity
• b.test-retest reliability
• c.predictive validity✓
• d.content validity

Predictive validity is a type of criterion-related validity in which test scores are correlated with a criterion measured later, such as job performance. Content validity concerns how well items sample the domain, test-retest reliability concerns score stability, and face validity is only whether a test appears to measure its target.

A client's observed score is 100 on a test whose standard error of measurement (SEM) is 3. Which range gives an approximately 95% confidence band for the client's true score?

• a.91 to 109
• b.94 to 106✓
• c.98 to 102
• d.97 to 103

A 95% band is about the observed score plus or minus 2 SEM (1.96 more precisely): 100 plus or minus 6 gives 94 to 106. Plus or minus 1 SEM (97 to 103) gives only about a 68% band, plus or minus 3 SEM (91 to 109) gives about 99.7%, and 98 to 102 matches no standard band.

A licensure exam sets a fixed passing score based on mastery of required content, regardless of how other candidates perform. This is an example of:

• a.ipsative interpretation
• b.percentile-rank interpretation
• c.criterion-referenced interpretation✓
• d.norm-referenced interpretation

Criterion-referenced interpretation compares performance with a fixed standard of mastery. Norm-referenced interpretation, including percentile ranks, compares a person with a reference group. Ipsative interpretation compares a person's scores with their own other scores.

A counselor wants to use a depression inventory with a recent immigrant client, but the instrument was normed only on U.S.-born adults. According to the ACA Code of Ethics, what is appropriate?

• a.Use it as normal, since standardized norms apply to all clients
• b.Use it with caution and interpret results in light of the client's culture✓
• c.Rely on the score alone to avoid subjective bias
• d.Translate the items into her language and score them with the published U.S. norms

ACA Code E.8 directs counselors to select and use with caution assessment techniques normed on populations other than the client's, and to consider culture, language and other factors when interpreting, placing results in perspective with other information. Assuming norms fit everyone ignores E.8. Translating items without permission violates E.10, and relying on a single score conflicts with E.6.a's preference for multiple sources of data.

To accommodate a client with a visual impairment, a counselor reads a standardized inventory aloud instead of having the client complete it as standardized. What does the ACA Code require?

• a.Report the scores without comment, since the accommodation was ethical
• b.Discard the results, since only standard administration is permitted
• c.Note the nonstandard conditions in the interpretation✓
• d.Rescore the inventory using norms for clients with disabilities

ACA Code E.7.a states that when assessments are not administered under standard conditions, as may be needed to accommodate clients with disabilities, those conditions are noted in interpretation and the results may be designated invalid or of questionable validity. Reporting without comment hides the change; accommodations are expressly contemplated, so discarding is not required; and no alternate norm set is assumed to exist.

According to SAMHSA TIP 50, which client behavior is a DIRECT warning sign of acute suicide risk?

• a.Looking for ways to obtain a firearm✓
• b.Driving recklessly after drinking
• c.Showing more irritability than usual
• d.Withdrawing from friends over several weeks

TIP 50 lists direct warning signs as suicidal communication, seeking access to a method (such as firearms or pills), and making preparations; these get the highest priority. Withdrawal, recklessness, and anger or mood changes are indirect warning signs in the IS PATH WARM mnemonic; they still require follow-up questions.

A client scores 16 on the PHQ-9. Using the severity bands published by the instrument's developers, this score indicates depression that is:

• a.severe
• b.moderate
• c.mild
• d.moderately severe✓

Kroenke, Spitzer and Williams (2001) set PHQ-9 cut points of 5, 10, 15 and 20 for mild, moderate, moderately severe and severe depression, so 15 to 19 is moderately severe. A score of 16 is above the moderate range (10 to 14) and below the severe range (20 to 27). The screen informs, but does not replace, a diagnostic interview.

A counselor wants a brief screening tool for hazardous and harmful alcohol use that was developed by the World Health Organization. Which instrument fits?

• a.BDI-II
• b.MMPI
• c.AUDIT✓
• d.Strong Interest Inventory

The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screen developed by the WHO covering alcohol consumption, dependence symptoms, and alcohol-related harm. The BDI-II measures depressive symptoms, the Strong Interest Inventory measures career interests, and the MMPI is a broad personality and psychopathology inventory.

A man with a terminal diagnosis tells his counselor, "If I can just live to see my daughter's wedding, I'll accept whatever comes after." In Kubler-Ross's model, this statement best reflects:

• a.anger
• b.denial
• c.bargaining✓
• d.acceptance

Kubler-Ross (On Death and Dying, 1969) described denial, anger, bargaining, depression, and acceptance. Bargaining involves trying to postpone the inevitable through a deal, here more time in exchange for acceptance later. Denial rejects the diagnosis, anger expresses rage or resentment, and acceptance does not attach conditions.

Which grief model describes mourning as a set of tasks the bereaved person actively works through rather than stages passed through?

• a.Bowlby's separation sequence
• b.Selye's general adaptation syndrome
• c.Worden's tasks of mourning✓
• d.Kubler-Ross's stages of dying

J. William Worden (Grief Counseling and Grief Therapy) framed mourning as tasks, such as accepting the reality of the loss and processing its pain, which casts the mourner as active. Kubler-Ross described stages observed in dying patients, Bowlby described protest, despair and detachment in separated children, and Selye's model describes the physiological stress response.

A woman's former partner of ten years dies, and she feels she has no right to grieve publicly because they had separated. Her experience best fits which concept?

• a.Disenfranchised grief✓
• b.Normal bereavement
• c.Delayed grief reaction
• d.Anticipatory grief

Doka (1989) defined disenfranchised grief as grief that is not openly acknowledged, socially sanctioned, or publicly mourned, for example when the relationship is not recognized, as with an ex-partner. Anticipatory grief occurs before an expected death, a delayed reaction is postponed grief, and normal bereavement does not capture the missing social recognition.

A 78-year-old client reviews her life and says she feels at peace with her choices, including her mistakes. In Erikson's theory, she is resolving which stage?

• a.Integrity versus despair✓
• b.Industry versus inferiority
• c.Intimacy versus isolation
• d.Generativity versus stagnation

Erikson's final stage, integrity versus despair, is the late-life task of accepting one's life as it was lived; the resolution is integrity. Generativity versus stagnation concerns guiding the next generation in middle adulthood, intimacy versus isolation concerns close relationships in young adulthood, and industry versus inferiority is a school-age stage.

A 45-year-old client says he feels his life is stuck and wants to mentor younger workers. In Erikson's theory, which stage do these concerns reflect?

• a.Integrity versus despair
• b.Initiative versus guilt
• c.Identity versus role confusion
• d.Generativity versus stagnation✓

Generativity versus stagnation is Erikson's middle-adulthood stage, centered on contributing to and guiding the next generation; feeling stuck is the stagnation pole. Identity versus role confusion is adolescent, integrity versus despair is late life, and initiative versus guilt belongs to early childhood.

A counselor is helping an 8-year-old manage worry. Given Piaget's account of this age, which approach best fits the child's thinking?

• a.Relying on insight into unconscious motives
• b.Using concrete examples and hands-on activities✓
• c.Asking the child to analyze thinking in general terms
• d.Debating abstract hypotheticals about the future

Around age 8 a child is typically in Piaget's concrete operational stage: logical about concrete, tangible situations but not yet reasoning well about abstract or hypothetical ones, which develops in the formal operational stage. Matching interventions to developmental level (NCE outline Domain 5A) means using concrete, hands-on methods rather than abstract debate or analysis.

A 19-year-old has committed to becoming a pharmacist because his parents expect it, but he has never explored other options. In Marcia's model, his identity status is:

• a.diffusion
• b.achievement
• c.moratorium
• d.foreclosure✓

Marcia (1966) classified identity status by exploration and commitment. Foreclosure is commitment without exploration, often adopting parental expectations. Moratorium is exploration without commitment yet, achievement is commitment after exploration, and diffusion is neither exploring nor committed.

In the Strange Situation, a toddler is very distressed when the caregiver leaves and, on reunion, both seeks contact and angrily resists it. Which attachment pattern does this describe?

• a.Disorganized
• b.Anxious-resistant (ambivalent)✓
• c.Anxious-avoidant
• d.Secure

Ainsworth and colleagues (1978) described the anxious-resistant, or ambivalent, infant as highly distressed by separation and mixing contact-seeking with angry resistance on reunion. Secure infants are comforted on reunion, avoidant infants show little distress and avoid the caregiver on return, and the disorganized category, added later by Main and Solomon, describes contradictory or disoriented behavior without a coherent strategy.

Bowlby described a sequence of responses in young children separated from their primary caregivers. What is the correct order?

• a.Detachment, protest, despair
• b.Protest, despair, detachment✓
• c.Protest, detachment, despair
• d.Despair, protest, detachment

Bowlby (Attachment and Loss, Vol. 2: Separation, 1973) described separated children first protesting (crying, searching), then showing despair (withdrawal, apathy), and finally detachment (apparent indifference on the caregiver's return). The other orders scramble that sequence.

A client enjoys teaching, helping, and counseling others and prefers working with people over machines. In Holland's typology, the matching personality type is:

• a.Conventional
• b.Realistic
• c.Social✓
• d.Investigative

Holland's RIASEC model describes the Social type as preferring to inform, train, help, or care for people. The Realistic type prefers work with tools, machines, or animals; the Conventional type prefers orderly work with data and procedures; and the Investigative type prefers observing and analyzing problems.

A 66-year-old client is reducing work hours and planning retirement. In Super's life-span, life-space theory, which career stage is he in?

• a.Disengagement✓
• b.Establishment
• c.Exploration
• d.Maintenance

Super's stages are growth, exploration, establishment, maintenance, and disengagement (earlier called decline), the last covering reduced work involvement and retirement in later life. Establishment is securing a place in an occupation, exploration is trying out roles, and maintenance is holding on to and updating one's position in mid-career.

A girl rules out engineering as "a job for boys" long before she knows what engineers do. Which theory best explains this narrowing of options?

• a.Gottfredson's circumscription and compromise✓
• b.Roe's theory of parent-child relations and occupational choice
• c.Holland's person-environment fit
• d.Krumboltz's social learning theory of career decision making

Gottfredson (1981) proposed that children progressively circumscribe acceptable occupations, eliminating those seen as the wrong sex type and later the wrong prestige level. Krumboltz's social learning theory explains career choice through learning experiences, Roe linked parent-child relationships to person- or non-person-oriented careers, and Holland matches personality type to work environment.

After being laid off, a client meets a stranger at a community event who mentions an unadvertised opening in a new field. A counselor helps her treat such chance events as opportunities. Which approach is this?

• a.Life-career rainbow
• b.Trait-and-factor matching
• c.Circumscription and compromise
• d.Planned happenstance✓

Mitchell, Levin, and Krumboltz (1999) described planned happenstance: helping clients generate, recognize, and use unplanned events through curiosity, persistence, flexibility, optimism and risk taking. Trait-and-factor matching pairs traits with job requirements, circumscription and compromise explains how options narrow, and the life-career rainbow is Super's depiction of life roles over time.

A client who immigrated five years ago keeps close ties to her heritage language and customs while also taking part fully in her new country's institutions. In Berry's model, this acculturation strategy is:

• a.integration✓
• b.assimilation
• c.marginalization
• d.separation

Berry defines integration as maintaining heritage culture while also participating in the larger society. Assimilation gives up the heritage culture, separation keeps the heritage culture while avoiding the larger society, and marginalization involves little connection to either.

An African American client describes an experience of racial discrimination that forced him to question his earlier view that race did not matter in his life. In Cross's model of Nigrescence, this marks which stage?

• a.Immersion-emersion
• b.Internalization
• c.Encounter✓
• d.Pre-encounter

In Cross's Nigrescence model, the encounter stage is triggered by an event that shatters the person's prior frame of reference about race. Pre-encounter is the earlier view that minimizes race, immersion-emersion follows with intense involvement in Black identity, and internalization reflects a secure, integrated identity.