National Counselor Examination (NCE) — All Questions

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.

A counselor tells a client of color, "I don't see color; everyone is the same to me." In Sue and colleagues' taxonomy, this remark is an example of a:

• a.macroaggression
• b.microassault
• c.microinvalidation✓
• d.microinsult

Sue et al. (2007) define microinvalidations as communications that exclude or nullify the experiences of people of color; color blindness is a listed example. Microassaults are explicit, deliberate attacks, microinsults convey rudeness or demean identity (for example, implying someone got a job because of race), and macroaggression is not part of that taxonomy.

A client says her partner hit her last week and has since been apologetic, bought her gifts, and promised it will never happen again. In Walker's cycle of violence, which phase is this?

• a.Acute battering incident
• b.Separation
• c.Tension building
• d.Loving contrition✓

Walker (The Battered Woman, 1979) described three phases: tension building, the acute battering incident, and loving contrition, in which the abuser apologizes, is kind, and promises change. Separation is not one of Walker's three phases.

Months of unrelenting work stress leave a client with frequent illness and depleted energy. In Selye's general adaptation syndrome, this reflects which stage?

• a.Resistance
• b.Recovery
• c.Exhaustion✓
• d.Alarm

Selye's general adaptation syndrome has three stages: alarm (initial mobilization), resistance (sustained adaptation to the stressor), and exhaustion, when prolonged stress depletes the body's resources and illness becomes more likely. Recovery is not one of the three named stages.

Which of the following is one of SAMHSA's principles of a trauma-informed approach?

• a.Confrontation of avoidance behavior
• b.Rapid exposure to trauma memories
• c.Clinician authority in all decisions
• d.Trustworthiness and transparency✓

SAMHSA's trauma-informed principles are safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural, historical and gender issues. Early exposure, clinician-controlled decisions, and confronting avoidance conflict with the collaboration, choice, and safety emphasis.

A survivor of repeated childhood abuse begins counseling with frequent nightmares and sudden dissociative episodes. According to SAMHSA TIP 57, what is the initial objective of trauma-informed treatment?

• a.Establishing safety✓
• b.Detailed retelling of the trauma
• c.Forgiving the people involved
• d.Confronting the perpetrator

TIP 57, drawing on Herman's model of trauma recovery, states that the initial objective of trauma-informed care is establishing safety, including safety from overwhelming symptoms. Detailed trauma processing comes later, if at all, and confronting or forgiving the perpetrator is not a prerequisite; TIP 57 notes forgiveness is not essential to recovery.

A client says his drinking is "no big deal" and he has no intention of changing it. In the stages of change model described in SAMHSA TIP 35, he is in:

• a.contemplation
• b.preparation
• c.action
• d.precontemplation✓

TIP 35 describes precontemplation as not considering change and having no intention to change in the foreseeable future, often without seeing a problem. Contemplation involves ambivalence and weighing change, preparation involves planning and small steps, and action is actively changing the behavior.

In the IS PATH WARM mnemonic in SAMHSA TIP 50, what does "Trapped" refer to?

• a.Being physically confined in a hospital or residential facility
• b.Feeling pressured by family members to enter substance use treatment
• c.Feeling there is no escape from a terrible situation✓
• d.Being unable to stop using a substance

TIP 50 explains that "Trapped" refers to perceiving a terrible situation from which there is no escape. It is not about physical confinement or family pressure, and substance abuse is a separate letter (S) in the mnemonic.

A client reports hearing a voice commenting on his actions when no one is present. In a mental status exam, this finding is recorded under:

• a.insight
• b.orientation
• c.thought process
• d.perception✓

Hallucinations, such as hearing voices no one else hears, are disturbances of perception and are documented in that MSE domain. Thought process describes how thoughts are organized, orientation covers awareness of person, place, and time, and insight is the client's understanding of their own condition.

A client with obsessive-compulsive symptoms washes her hands dozens of times a day. According to NIMH, which psychotherapy approach specifically targets this pattern?

• a.Exposure and response prevention✓
• b.Supportive listening alone
• c.Reassurance after each urge to wash
• d.Psychoanalytic dream interpretation

NIMH describes exposure and response prevention (ERP), a specific type of CBT, as gradually exposing people to situations that trigger obsessions while preventing the usual compulsive response, and reports it reduces compulsive behaviors. Dream interpretation and supportive listening do not target the compulsion, and repeated reassurance works like a compulsion that maintains the cycle.

A client with panic attacks avoids exercise because a racing heart frightens her. The counselor has her deliberately bring on a fast heartbeat in session to reduce her fear of the sensation. This technique is called:

• a.thought stopping
• b.interoceptive exposure✓
• c.aversive counterconditioning
• d.in vivo flooding

NIMH describes interoceptive exposure as exposure that targets the bodily sensations associated with panic attacks, often paired with breathing and relaxation techniques. In vivo flooding is prolonged exposure to feared external situations, thought stopping interrupts thoughts, and aversive counterconditioning pairs a behavior with an unpleasant stimulus to reduce it.

A client with chronic insomnia lies awake in bed for hours every night. Which instruction is part of stimulus control therapy?

• a.Get out of bed if unable to fall asleep and return only when sleepy✓
• b.Stay in bed later in the morning to make up for sleep lost during the night
• c.Read and watch TV in bed until drowsy
• d.Take a long nap in the afternoon after a poor night

Stimulus control (Bootzin) aims to re-associate the bed with sleep: go to bed only when sleepy, use the bed only for sleep (and sex), leave the bed if unable to sleep and return when sleepy, keep a fixed wake time, and avoid daytime naps. Sleeping in, activities in bed, and long naps each weaken that association and are counter to the instructions.

A client regularly eats unusually large amounts of food with a sense of loss of control, but does not vomit, use laxatives, or otherwise compensate. As NIMH describes eating disorders, this pattern best matches:

• a.binge-eating disorder✓
• b.anorexia nervosa
• c.bulimia nervosa
• d.avoidant/restrictive food intake disorder

NIMH describes binge-eating disorder as regularly losing control of eating and eating unusually large amounts, without the compensatory behaviors that characterize bulimia nervosa, such as forced vomiting or laxative use. Anorexia nervosa involves severe restriction and fear of weight gain, and avoidant/restrictive food intake disorder involves limiting food intake rather than binge episodes.

Slot machines pay out after an unpredictable number of plays. Which reinforcement schedule is this?

• a.Fixed ratio
• b.Variable ratio✓
• c.Fixed interval
• d.Variable interval

Reinforcement delivered after an unpredictable number of responses is a variable-ratio schedule; it produces high, steady responding that is highly resistant to extinction, which helps explain persistent gambling. A fixed-ratio schedule pays after a set number of responses, and fixed- and variable-interval schedules depend on elapsed time rather than the number of plays.

A client with intense emotional swings needs skills to get through a crisis urge without making the situation worse. Which DBT skills module is designed for this?

• a.Distress tolerance✓
• b.Emotion regulation
• c.Core mindfulness
• d.Interpersonal effectiveness

In Linehan's DBT, distress tolerance skills are for surviving crises and accepting reality without acting in ways that make things worse. Interpersonal effectiveness addresses asking for what one needs and saying no, emotion regulation addresses understanding and changing emotions over time, and mindfulness is the foundational awareness skill.

Parents in a family session set clear rules and high expectations while being warm, responsive, and willing to explain their reasons. In Baumrind's typology, this parenting style is:

• a.authoritarian
• b.authoritative✓
• c.uninvolved
• d.permissive

Baumrind described authoritative parents as combining high demands and firm control with warmth, responsiveness, and reasoning. Authoritarian parents are demanding but low in warmth and explanation, permissive parents are warm but make few demands, and uninvolved (neglectful), a category added by Maccoby and Martin, is low on both.

A client facing a serious illness asks, "What is the point of any of this?" and feels deeply alone despite supportive family. Which framework names meaninglessness and isolation as ultimate concerns of existence?

• a.Minuchin's structural therapy
• b.Yalom's existential therapy✓
• c.Beck's cognitive therapy
• d.Skinner's operant conditioning

Yalom (Existential Psychotherapy, 1980) identified four ultimate concerns: death, freedom, existential isolation, and meaninglessness. Beck's cognitive therapy targets distorted thoughts, operant conditioning addresses behavior and its consequences, and structural therapy addresses family boundaries and hierarchy.

A terminally ill client who is considering hastening his own death asks whether the counselor must report this. According to the ACA Code of Ethics, what applies?

• a.The counselor may keep it confidential, depending on law and consultation✓
• b.The counselor must notify law enforcement before the client leaves the session
• c.The counselor must end counseling and refer the client
• d.The counselor must break confidentiality and notify the client's family members

ACA Code B.2.b states that counselors serving terminally ill clients considering hastening their own deaths have the option to maintain confidentiality, depending on applicable laws and the circumstances, after seeking consultation or supervision from appropriate professional and legal parties. The Code does not require notifying family or police or ending the relationship; B.2.a also notes that additional considerations apply to end-of-life issues.

A devout client says her faith is central to how she copes with her divorce. How does the ACA Code of Ethics describe the counselor's role regarding her religious community?

• a.Avoid discussing religion altogether so as not to impose personal values
• b.Refer the client to clergy instead of counseling
• c.Ask her religious leader for background information without telling her
• d.Consider involving religious leaders as resources, with client consent✓

ACA Code A.1.d says counselors recognize that support networks hold various meanings and consider enlisting religious/spiritual/community leaders, family members, and friends as positive resources, when appropriate, with client consent. Avoiding the topic ignores a stated strength, replacing counseling with clergy is not required, and contacting anyone without consent breaches confidentiality.

During a session, a 9-year-old discloses that a parent burns him with cigarettes. Regarding confidentiality, which statement is consistent with the ACA Code of Ethics?

• a.Confidentiality applies because the child's parent, not the child, is the legal client
• b.Confidentiality applies unless the child agrees to a report
• c.Confidentiality does not apply when law requires disclosure to protect the child✓
• d.Confidentiality applies until the parent consents to disclosure

ACA Code B.2.a states that the general requirement to keep information confidential does not apply when disclosure is required to protect clients from serious and foreseeable harm or when legal requirements demand it; child abuse reporting duties are set by state law, which the counselor follows. Waiting for parental consent or the child's agreement, or treating the parent as the client, would leave the child unprotected.

A client says, "No matter what I do, nothing changes, so why try?" after years of uncontrollable setbacks. Which concept best explains this pattern?

• a.Cognitive dissonance
• b.Negative reinforcement
• c.Learned helplessness✓
• d.Reaction formation

Seligman's learned helplessness describes giving up after repeated exposure to events that seem uncontrollable, and it has been linked to depression and hopelessness. Negative reinforcement increases a behavior by removing an aversive stimulus, cognitive dissonance is discomfort from conflicting beliefs, and reaction formation is a defense of expressing the opposite of an unacceptable impulse.