National Clinical Mental Health Counseling Examination (NCMHCE) — All Questions

Frank, 50, is mandated to counseling after a DUI; the intake diagnosis is alcohol use disorder, mild. He sits with his arms crossed and says, 'I'm only here because the judge said so.' The counselor wants to engage him and learn about his drinking. Which response is the BEST example of an open question?

• a."Do you think you have a drinking problem?"
• b."How many drinks did you have the night you were arrested?"
• c."You know drinking and driving is dangerous, right?"
• d."Tell me about a typical evening when you drink."✓

TIP 35 describes open questions as ones that invite clients to reflect and tell their story, including statements that begin with 'Tell me about,' while closed questions call for yes/no or short answers. Asking about a typical evening invites Frank to describe his drinking in his own words. Asking for a number of drinks and asking whether he has a problem are closed questions, and the second also invites a defensive 'no.' The last is a leading question that lectures, one of Gordon's roadblocks, and is likely to increase discord.

Nate, 32, uses cannabis daily; the intake diagnosis is cannabis use disorder, mild. At session 3 he says, 'I know my daughter hates that the apartment smells like weed, but honestly nothing else calms me down after work.' Which counselor response is a double-sided reflection?

• a."Smoking helps you unwind, and you see how it affects her."✓
• b."So there's no way you could ever relax without smoking."
• c."Your daughter hates the smell of weed in the apartment."
• d."Have you thought about smoking outside so she isn't bothered?"

TIP 35 describes a double-sided reflection as acknowledging sustain talk and pairing it with change talk, joined with 'and,' with the change-talk side last. Reflecting that cannabis helps him relax and that he sees its effect on his daughter does this. Repeating only the daughter's reaction is a simple reflection. The overstated 'no way you could ever relax' is an amplified reflection. Suggesting he smoke outside is advice, not a reflection, and comes before he has asked for it.

Ray, 60, has gambling disorder, diagnosed at intake, and has lost $40,000 this year. His wife insisted he come. He says, 'It's not a problem. I always win it back eventually.' The counselor wants to respond in a way that may lead Ray to argue the other side himself. Which response is an amplified reflection?

• a."What would your wife say about that?"
• b."You don't see gambling as a problem."
• c."$40,000 is clearly a serious problem."
• d."So the losses don't worry you at all."✓

TIP 35 describes an amplified reflection as restating the client's point with added emphasis, without sarcasm, which can nudge the client toward the other side of his ambivalence. Saying the losses don't worry him at all overstates his view and invites him to qualify it. The simple restatement that he is not convinced does not amplify. Telling him it is 'clearly a serious problem' is arguing, which tends to entrench sustain talk. Asking what his wife would say is a question, not a reflection.

Elena, 38, has alcohol use disorder, moderate, and has been ambivalent about cutting down. At session 5 she says, 'I'm going to pour out everything in the house tonight, and I promise I'll call the outpatient program tomorrow morning.' Which type of change talk is Elena expressing?

• a.Reasons
• b.Desire
• c.Ability
• d.Commitment✓

TIP 35 uses DARN-CAT to classify change talk. Desire is wanting change ('I want to'), Ability is feeling capable of it ('I could'), Reasons are arguments for change, and Need is urgency. Commitment is a promise to change, as in 'I promise I'll call the program tomorrow,' followed by Activation and Taking steps. Her words are a clear promise with a specific action, so they are commitment language rather than desire, ability, or reasons.

Greg, 48, has alcohol use disorder, mild. He tells the counselor, 'I know the drinking is part of why my wife and I fight, and I don't like how I feel in the mornings. But it's how I unwind, and I'm not sure I want to give it up.' Which approach is MOST appropriate for his current stage of change?

• a.Move straight to a detailed plan to stop drinking this week
• b.Normalize his ambivalence and evoke his own reasons✓
• c.Present the medical risks of drinking to convince him to quit
• d.Focus on relapse-prevention skills for high-risk situations

Greg is weighing pros and cons and is still using, which fits TIP 35's description of Contemplation. In Contemplation, the counselor's focus is to normalize and resolve ambivalence and help tip the decisional balance, for example by drawing out desire, ability, reasons, and need, and summarizing his concerns. Jumping to a stop plan fits a later stage (Preparation or Action) and risks the premature-focus trap. Relapse prevention is for people who have already changed. Trying to convince him is the righting reflex, which tends to produce sustain talk.

Stepfather Wade, 40, comes to counseling only because his new wife said she would leave if he did not. The intake diagnosis is stimulant use disorder, mild. He says his weekend methamphetamine use 'doesn't hurt anyone' and he has no plans to change. Which counseling focus is MOST appropriate at this stage?

• a.Confront his denial until he accepts that he is an addict
• b.Develop a written plan with a specific quit date
• c.Teach relapse-prevention skills for his weekend triggers
• d.Build rapport and gently raise doubts about his use✓

Wade sees no problem and has no intention to change, which TIP 35 describes as Precontemplation. TIP 35's chapter on moving from Precontemplation to Contemplation focuses on building rapport and trust and raising doubts and concerns about substance use. Relapse-prevention skills are for clients who have already begun to change. The ASAM training materials list 'clients in early stages of change need relapse prevention strategies' as a false statement. A quit-date plan is premature. Forcing a label falls into the labeling trap.

Midway through session 2, the counselor urged Dominic, 27, whose intake diagnosis is opioid use disorder, to enter a residential program. Dominic crossed his arms, interrupted, and said, 'You sound like my mother. I'm not going anywhere.' The counselor recognizes growing discord. Which response is MOST consistent with motivational interviewing?

• a."I'm only telling you what's best for you, so please hear me out."
• b."Your mother is right, and that's why you should listen to her too."
• c."It's your decision what you do next; nobody can make it for you."✓
• d."If you don't go to residential now, you are going to overdose."

TIP 35 describes discord as a sign of trouble in the relationship, often set off by the counselor pushing for change (the righting reflex), and suggests responses such as emphasizing personal autonomy or shifting focus. Stating that the decision is his reduces the power struggle. Insisting that the counselor knows best continues the push. The overdose warning is one of Gordon's roadblocks (warning or threatening). Siding with his mother deepens the discord.

Kara, 35, is drinking more since her promotion; the intake diagnosis is alcohol use disorder, mild. Asked, 'On a scale of 0 to 10, how important is it for you to cut back?', she answers, 'Maybe a 5.' Which follow-up question is MOST likely to evoke change talk?

• a."Why isn't it a 10?"
• b."Why a 5 and not a 9?"
• c."Is a 5 good enough for you?"
• d."Why a 5 and not a 2?"✓

TIP 35's Importance Ruler guidance says to ask why the client is at their number rather than a lower one. The answer describes reasons it already matters to her, which is change talk. Asking why not a higher number, such as 9 or 10, tends to evoke sustain talk (reasons not to change). 'Is a 5 good enough?' is a closed question that may sound judgmental.

Keith, 30, has major depressive disorder and reports thoughts of suicide without a current plan. After consultation, the counselor decides he can safely continue outpatient care. The clinic's old protocol says to have him sign a 'no-suicide contract.' Which intervention is MOST consistent with current SAMHSA guidance?

• a.Build a personal safety card with him, including 988✓
• b.Hand him a printed list of crisis numbers
• c.Have Keith sign the no-suicide contract
• d.Have him call the counselor's cell anytime

TIP 50 says suicide contracts are not recommended and are never sufficient on their own. It recommends a safety card created with the client, not just handed to him, listing a 24-hour crisis line, the nearest emergency department, the counselor's contact information, and supportive people. The 24-hour line is now the 988 Suicide & Crisis Lifeline, which answers calls, texts, and chats 24/7. A pre-printed handout is less personal than the card TIP 50 describes. Relying only on the counselor's personal phone around the clock is not a dependable crisis plan.

Lorraine, 57, has major depressive disorder and has had recurring thoughts of shooting herself since her husband's death, with no intent to act today. Her husband's handgun is still in her bedroom closet. She is willing to have her brother keep it for now. After consulting a supervisor, which action should the counselor prioritize?

• a.Focus the session on grief work, since the gun belonged to her husband
• b.Advise her to keep the gun unloaded in the closet instead of moving it
• c.Arrange with Lorraine and her brother to store the gun elsewhere✓
• d.Document the gun and revisit the topic if her thoughts become more frequent

TIP 50 lists restricting access to means of suicide among responsible actions, and gives the example of arranging, with a family member, removal and safe storage of a gun. Lorraine's thoughts involve a specific method that is readily available, so reducing access is a priority, and doing it collaboratively respects her autonomy. Only documenting and waiting leaves the method in place. Grief work matters but does not address the immediate means. Keeping the gun unloaded in the closet still leaves the method within easy reach.

Darius, 25, is in session for major depressive disorder. He says calmly that he has saved up a bottle of his mother's sleeping pills, plans to take them tonight after she goes to work, and does not want to be stopped. He will not agree to any alternative. The counselor is in an agency where a supervisor is on site. What should the counselor do FIRST?

• a.Ask Darius to sign an agreement not to harm himself before he leaves
• b.Stay with him, get the supervisor now, and arrange an emergency evaluation✓
• c.Let him leave and call his mother later to warn her about the pills
• d.Develop a safety card with him and schedule a check-in call for tomorrow

Darius has a plan, access to a method, intent, and a time frame, which are direct warning signs of acute risk. TIP 50 calls for immediate supervision or consultation in that situation and lists immediate actions such as arranging transportation to an emergency department for evaluation. NIMH advises calling 911 when a situation is life-threatening. A safety card with a call tomorrow does not match the seriousness. A no-harm agreement is not recommended and never sufficient. Letting him leave abandons him at the moment of highest risk.

While describing a car crash that killed her friend, Mei, 26, whose intake diagnosis is PTSD, suddenly stops talking. Her eyes look fixed and glazed, her face goes flat, and she does not respond when the counselor says her name softly. What should the counselor do FIRST?

• a.Encourage her to keep describing the crash to finish the memory
• b.Step out to consult a supervisor about what to do
• c.Use grounding to bring her attention back to the present room✓
• d.Ask detailed questions about what she is seeing in the memory

TIP 57 lists fixed or 'glazed' eyes, sudden flattening of affect, and long silences as possible signs of dissociation, and says grounding techniques help a person who is overwhelmed or dissociating reconnect with the present moment. Examples include naming what she observes in the room, noticing her feet on the floor, and slow breathing. Pushing her to continue the memory or asking detailed questions about it deepens the dissociation. Leaving the room to consult leaves her alone in it; consultation can follow once she is grounded.

Sergio, 40, has PTSD and alcohol use disorder, diagnosed at intake, and began trauma-focused work 3 weeks ago. Since then he has resumed daily drinking, missed work, stopped showering, and started cutting his forearm. In today's session he becomes agitated when the trauma is mentioned. What should the counselor do?

• a.Increase trauma work to twice weekly
• b.Continue; symptoms often worsen first
• c.Pause the trauma work and focus on support and coping✓
• d.End treatment unless he stops drinking

TIP 57 separates the normal ups and downs of recovery from destabilization, which it defines by signs such as increased substance use, self-harm, and a notable decline in daily activities, all of which Sergio shows. Its first strategy is to stop exploring the material that triggered the reaction, offer emotional support, and teach self-soothing, and to consult and consider a higher level of care if needed. Pressing on or speeding up the trauma work risks further harm. An ultimatum ignores that his drinking is part of the destabilization.

Near the end of a session in which Ashley, 31, talked about childhood abuse for the first time, she is shaky and tearful. Her intake diagnosis is PTSD. She says she has to drive to pick up her son from day care in 15 minutes. Before she leaves, what should the counselor do?

• a.End on time and trust that she will feel better once she is busy
• b.Check that she is grounded and has a plan for the rest of the day✓
• c.Ask her to continue the abuse story so she can process it fully today
• d.Schedule her next session for a month out to give her time to recover

TIP 57 advises making sure the client is grounded and safe before leaving the session, and gives ways to judge readiness: how aware she is of her current surroundings, her plan for staying safe, and her plans for the rest of the day. That matters here because she is about to drive with her child. Ending without checking, or opening more material when little time remains, ignores her state. A long gap after a first disclosure leaves her without support.

A day after a tornado destroyed much of a small town, a counselor volunteers at a shelter. Doreen, 66, lost her home and her dog and is shaking, asking where she will sleep and whether her medications can be replaced. A shelter coordinator suggests the counselor lead a group where survivors describe the tornado in detail to 'get it out.' What should the counselor do?

• a.Lead the group retelling the tornado in detail
• b.Offer safety, comfort, and help with immediate needs✓
• c.Start a full diagnostic PTSD interview
• d.Refer her to weekly counseling and move on

TIP 57 describes psychological first aid in the first hours after a disaster: contact and engagement, safety and comfort, stabilization, attention to current needs, practical help (such as shelter and medications), and connection to support. It notes that single-session debriefing has not been shown to prevent later problems and may impede natural recovery. A diagnostic interview on day one is premature, since most reactions lessen over time (NIMH). A weekly counseling referral alone leaves her immediate needs unmet.

Jacob, 35, a veteran with PTSD diagnosed at intake, has not driven on the interstate since a roadside explosion overseas. He relies on his wife for rides and wants to be able to drive to his new job. He is not currently in any danger and is stable. Which intervention MOST directly targets his avoidance?

• a.Encouraging him to talk only about present-day stressors
• b.Relaxation training alone, without approaching driving
• c.Teaching him to avoid the interstate using alternate routes
• d.Graded exposure to driving, starting with the least feared✓

NIMH describes exposure therapy for PTSD as helping people face and control their fear by gradually exposing them, in a safe way, to reminders of the trauma, and names cognitive restructuring as another talk-therapy approach. A graded approach to driving, starting with easier situations and moving up, targets his avoidance directly. Planning alternate routes maintains the avoidance. Talking only about present-day stress and relaxation alone do not address the feared situations.

Wes, 42, has OCD, diagnosed at intake. He checks that the stove is off 20 to 30 times before leaving home and is late to work almost daily. He knows the stove is off but feels he 'can't risk it.' Which intervention is the evidence-based psychotherapy for his compulsions?

• a.Free association about his childhood
• b.Exposure and response prevention✓
• c.Thought stopping by snapping a rubber band
• d.Reassurance that the stove is off each time he checks

NIMH identifies exposure and response prevention (ERP), a type of CBT, as an effective psychotherapy for OCD: the person gradually faces situations that trigger obsessions while resisting the urge to perform compulsions. For Wes that means leaving after one check while tolerating the anxiety. Giving reassurance works like another check and keeps the cycle going. Free association and rubber-band thought stopping are not the evidence-based treatment NIMH describes for OCD.

Selena, 30, has panic disorder, diagnosed at intake, after medical causes were ruled out. She has stopped exercising because a racing heart feels 'exactly like an attack starting,' and she now avoids stairs and coffee as well. Which CBT technique MOST directly targets her fear of these body sensations?

• a.Guided imagery of a peaceful beach
• b.Interoceptive exposure✓
• c.Systematic avoidance of cardio exercise
• d.Journaling about her childhood fears

NIMH names exposure therapy and interoceptive exposure among the CBT methods for panic disorder. Interoceptive exposure has the person deliberately bring on the feared body sensations, such as a raised heart rate, in a safe setting so she learns they are not dangerous. Avoiding exercise keeps the fear going. Guided imagery and journaling may ease stress but do not directly target her fear of the physical sensations.

Paula, 41, has major depressive disorder, diagnosed at intake. After a single critical comment from her manager, she says, 'I'm a complete failure; I'll be fired soon.' She has had strong reviews for 6 years. The counselor is using cognitive behavioral therapy. Which intervention is MOST consistent with that approach?

• a.Explore her early childhood relationship with her father in depth
• b.Reassure her that her manager surely did not mean the comment
• c.Advise her to look for a new job before she can be fired
• d.Help her test the evidence for the thought 'I'm a failure'✓

NIMH describes CBT as helping a person notice automatic thoughts that are distorted or unhelpful, challenge them, and see how they affect emotions and behavior. Examining evidence for the all-or-nothing thought 'I'm a complete failure,' such as her 6 years of strong reviews, is that process. Reassurance is a roadblock that does not teach her to evaluate her thinking. In-depth exploration of childhood belongs to other approaches. Advising a job search acts on the distorted thought.

Tiffany, 23, has borderline personality disorder, diagnosed at intake. She describes intense mood shifts within hours, chronic emptiness, and a history of cutting when overwhelmed after arguments. She wants to 'stop exploding' at people she cares about. Which treatment approach BEST fits NIMH's description of evidence-based care for her?

• a.Psychoanalysis focused on dream interpretation
• b.Medication as the first-line treatment
• c.Brief solution-focused therapy for 3 sessions
• d.Dialectical behavior therapy✓

NIMH names dialectical behavior therapy (DBT) as a main treatment for borderline personality disorder. DBT uses mindfulness and teaches skills for managing intense emotions, reducing self-destructive behavior, and improving relationships, which matches Tiffany's goals and self-harm history. NIMH states medication is not a first-line treatment for BPD, though it may help specific symptoms. A 3-session solution-focused course and dream-focused psychoanalysis are not the evidence-based approaches NIMH describes.

In family counseling for Noah, 13, who has been caught shoplifting, the counselor notices that whenever his parents start to disagree about money, the father turns to criticize Noah's grades and the mother rushes to defend him. The parents' disagreement never gets resolved. Which family-systems concept BEST describes this pattern?

• a.Complementarity
• b.Disengagement
• c.Triangulation✓
• d.Differentiation

TIP 39, citing Bowen, describes triangulation as two family members who face a sensitive issue shifting their energy to a third member, who becomes a go-between, scapegoat, or ally. This eases their tension but keeps the conflict unresolved. Each time the parents' money argument starts, they turn to Noah. Differentiation refers to keeping one's individuality within the family. Complementarity describes partners taking on reciprocal roles. Disengagement is emotional distance, not this three-way pattern.

In a family session about adjustment issues after adopting 12-year-old Lily from foster care, the adoptive father repeatedly answers questions directed to Lily, saying things like, 'She's fine with the new school, she just doesn't say much.' Lily looks at the floor. Using a structural family therapy technique, what should the counselor do?

• a.Direct all future questions to the father to show respect for his role
• b.Point out the pattern and invite Lily to speak for herself✓
• c.Accept the father's answers, since he knows Lily best
• d.Ask the father to leave so that Lily can speak freely

TIP 39 says a basic structural technique is marking boundaries so each member is responsible for himself or herself, in part by making the family aware when one member speaks for another who is present, and by encouraging members to speak for themselves. Inviting Lily to answer does that. Accepting the father's answers keeps the pattern going. Sending him out avoids the family pattern rather than working with it. Routing all questions through him silences Lily further.

Carla, 45, has alcohol use disorder, moderate, and attends family sessions with her husband. She says, 'Our weekends are always a disaster; I drink and we fight.' Using a solution-focused approach, which question should the counselor ask?

• a."Tell me about a weekend when things went better."✓
• b."How many drinks do you have on weekends?"
• c."What was your parents' drinking like?"
• d."Why do you keep drinking on weekends?"

TIP 39 describes a solution-focused technique of asking about exceptions, times when the problem was not happening or was happening less, and then examining what was different so it can be repeated. This builds on the family's strengths rather than their problems. Asking about her parents' drinking looks for past origins, which solution-focused work does not emphasize. 'Why' questions tend to invite justification, and counting drinks is an assessment question rather than a solution-focused one.

Four months after his father, Gary, 50, stopped drinking, 10-year-old Ethan has started lying and picking fights at school. Gary's wife, Helen, says, 'Things should be better now, not worse.' Gary has alcohol use disorder, severe, in early remission. Which explanation is MOST useful for the counselor to share with the family?

• a.It proves Gary's recovery is not real
• b.The family may be reacting to losing its old balance✓
• c.It is unrelated to his father's drinking
• d.Ethan likely needs separate conduct treatment

TIP 39 describes homeostasis, the tendency of families to resist change to keep their balance, and notes that when a member stops using, other members may react negatively; for example, children may act out to restore the old dynamics. Explaining this helps the family understand Ethan's behavior as part of a system adjusting to recovery. It is not proof that recovery is fake, and it is not unrelated to the change. Labeling Ethan with a separate disorder right away overlooks the family pattern.

In the second meeting of a support group for adults whose parents have dementia, Rachel, 48, says, 'I'm the only one who feels relieved sometimes when I leave my mother's nursing home, and I hate myself for it.' Several members nod. Which leader intervention BEST promotes universality through linking?

• a.Ask who else has felt this way and connect them to Rachel✓
• b.Reassure Rachel that relief is normal and move on to the next topic
• c.Explain the stages of caregiver stress in a short lecture
• d.Ask Rachel to explore the reasons for her guilt one-on-one after group

TIP 41 lists universality, seeing that others have similar problems, among Yalom's therapeutic factors and stresses it early in a group. Linking, connecting one member's disclosure to others who share it, draws on the nodding members so Rachel learns she is not alone. Reassuring her and moving on skips the group's own resources. Moving the topic to a private talk takes it out of the group. A lecture shifts to teaching when a connection between members is ready to happen.

In an outpatient group for co-occurring anxiety and substance use, members have started blaming Jin, 34, the only Asian American member, whenever the group feels stuck, and one member mocked his accent tonight. Jin has gone silent. What should the group leader do?

• a.Stop the mocking right away and address the scapegoating with the group✓
• b.Speak with the member who mocked Jin privately after the session
• c.Suggest to Jin that he may fit better in a different group
• d.Let the group work it out, since conflict is a normal part of development

ACA A.9.b requires group counselors to take reasonable precautions to protect members from physical, emotional, or psychological trauma. TIP 41 warns that failing to make it safe to talk about race in multiethnic groups leads to scapegoating, and says leaders should respond quickly and clearly to patterns that impede group work. Blocking the mocking now and naming the scapegoating pattern protects Jin and the group. Waiting, dealing with it only in private later, or moving Jin puts the burden on the person being targeted.

A counselor is leading the third session of a new outpatient group for adults in early recovery from opioid use disorder. Several members are anxious and one relapsed last week. A co-leader proposes an intense exercise in which each member reenacts a painful family-of-origin conflict. What should the leader do at this stage?

• a.Postpone it and focus on cohesion, hope, and safety✓
• b.Proceed, because emotional catharsis speeds early recovery
• c.Proceed only with the members who have not relapsed
• d.Replace group sessions with individual family-of-origin therapy

TIP 41 explains that early in treatment, clients can be emotionally fragile and ambivalent. Leaders should focus on hope, group cohesion, and universality, and defer highly charged factors such as catharsis and reenactment of family-of-origin issues until the group is well established. Doing the exercise now, with or without the members who relapsed, ignores that guidance. Replacing the group entirely gives up its benefits.

Two members of a 12-week recovery group, Brandon, 30, and Kelsey, 28, both with alcohol use disorder, tell the leader privately that they have started dating outside the group and ask the leader not to tell anyone. The group agreement discourages outside relationships and asks that contacts outside group be discussed openly in group. What should the leader do?

• a.Keep their secret, since what they do outside group is private
• b.Announce the relationship to the group at the next session
• c.Remove both members from the group immediately
• d.Encourage them to raise it in group, per the agreement✓

TIP 41 says group agreements should discourage personal contact outside the group, remind members that new intimate relationships are hazardous to early recovery, and state that any outside contact should be discussed openly in the group. Referring them back to the agreement and encouraging them to bring it up themselves respects both the agreement and their autonomy. Keeping the secret undermines the group norm. Removing them immediately is punitive. Announcing it for them takes away their choice to disclose it.

Colleen, 44, comes to counseling for stress about her 16-year-old son; she has an adjustment disorder diagnosis. She says, 'He argues about every single rule I set. He's just defiant and disrespectful.' She also mentions he wants to take on more responsibility, like getting a job. Which counselor response is an example of reframing?

• a."His arguing may be practice at being independent."✓
• b."Set firmer consequences so he stops."
• c."All teens are defiant; wait it out."
• d."You're frustrated by his arguing."

TIP 35 describes reframing as acknowledging the client's experience while offering a different meaning for it, which invites a new perspective. Suggesting that her son's arguing may reflect a push for independence, which fits his wish to take on a job, is a reframe. Saying all teens are defiant is a generalization and a reassuring roadblock. Advice about consequences is directive and premature. Reflecting her frustration is an empathic reflection, not a reframe.

Rafael, 36, has alcohol use disorder, moderate. He says being a good father is 'the most important thing in my life.' Later in the session he mentions he sometimes drives his kids to soccer after 'a few beers' but says 'it's no big deal.' Which intervention BEST develops discrepancy in the spirit of motivational interviewing?

• a.Reflect the gap between his values and his drinking and driving✓
• b.Report him to child protective services before exploring further
• c.Tell him directly that driving after drinking makes him a bad father
• d.Drop the topic, since he said it was no big deal

TIP 35 describes developing discrepancy as a values conversation: exploring what matters to the client and then highlighting the conflict between those values and current behavior, in a spirit of acceptance and compassion. Reflecting his commitment to fatherhood alongside the drinking and driving invites him to feel the gap himself. Calling him a bad father is shaming and labeling, which increases discord. Moving to a report without exploring the risk first skips assessment. Dropping the topic ignores a safety concern.

A counselor sees Irene, 39, by video for generalized anxiety disorder, diagnosed at intake. Irene travels for work and joins sessions from different hotels. At the start of today's video session the connection is clear and Irene appears ready. What should the counselor do at the beginning of this and every telehealth session?

• a.Ask Irene to rate the video quality on a 1-10 scale
• b.Confirm that the video platform is the same as last time
• c.Verify Irene's identity and her current location✓
• d.Remind Irene of the fee for sessions missed due to travel

NBCC standard 106 requires written procedures for verifying each telehealth client's identity, current location, and readiness at the start of each contact, and ACA H.3 asks counselors to verify client identity throughout the process. Knowing Irene's location matters because emergency procedures depend on responders near where she is. Checking the platform, rating the video, or reviewing the fees may be useful but are not the core safety step.

Harold, 58, has alcohol use disorder, severe, and completed medically supervised withdrawal last month. He says, 'I'd try a medicine if it helped, but I don't want to trade one addiction for another.' The counselor wants to give him accurate psychoeducation. Which statement is accurate according to NIAAA?

• a.There are FDA-approved medications for AUD that are nonaddictive✓
• b.No medications are approved; counseling is the only effective option
• c.Medications for AUD are addictive and are used only as a last resort
• d.AUD medications replace the need for any behavioral treatment

NIAAA states that three medications are FDA-approved to help people stop or reduce drinking and prevent a return to drinking (naltrexone, acamprosate, and disulfiram), that all are nonaddictive, and that they can be used alone or combined with behavioral treatment and mutual-support groups. The counselor can share this and encourage Harold to discuss options with a prescriber. The other statements contradict NIAAA: the medications are not addictive, approved options exist, and they complement rather than replace behavioral care.

Herb, 70, recently retired and widowed, has persistent depressive disorder. This week he went to a community center for the first time, though he left early because he felt awkward. He says, 'I didn't even last an hour; I'm hopeless at this.' Which response is the BEST affirmation?

• a."Great job! Next week you'll stay the whole time."
• b."Don't be so hard on yourself; it will get easier."
• c."You pushed yourself to go, even though it felt awkward."✓
• d."I'm really proud of you for going to the community center."

TIP 35 describes affirmations as genuine recognition of the client's strengths and efforts, framed with 'you' rather than 'I,' and focused on specific behaviors. Noting that Herb pushed himself to go despite discomfort affirms a specific effort. 'I'm proud of you' puts the focus on the counselor. General praise like 'great job' can be a roadblock, and the added prediction puts pressure on him. 'Don't be so hard on yourself' is reassurance rather than affirmation.

In a process group for adults with anxiety, Lorenzo, 45, has been talking for several minutes about his conflict with his sister. The leader notices Beth, 38, whose intake diagnosis is social anxiety disorder, shifting in her seat and frowning as he speaks. The leader wants to bring the group into the here and now. Which intervention BEST does that?

• a."Beth, you seem to be reacting to this. What's happening for you?"✓
• b."Beth, what was your relationship with your own siblings like as a child?"
• c."Let's each take a turn describing a conflict we had with a sibling."
• d."Lorenzo, tell us more about the history of your conflict with your sister."

TIP 41 notes that most leaders try to hold attention on what is happening in the room, and gives a model prompt: 'You seem to be responding to what Jane was sharing. Can you tell us something about what was going on for you as she was talking?' Inviting Beth to put her in-the-moment reaction into words brings present interactions into the group. More history about Lorenzo's sister, sibling stories from each member, and Beth's childhood all turn the group toward the past and outside relationships.

Joanna, 29, who is Deaf and communicates in American Sign Language, is in counseling for major depressive disorder with an interpreter present. She has had passing suicidal thoughts and no plan. While building her safety plan, she asks how she could reach crisis support at 2 a.m. without a voice call. What accurate information can the counselor give?

• a.Crisis lines are open only during business hours, so she should wait
• b.The 988 Lifeline is available 24/7 and can be reached by text or chat✓
• c.The 988 Lifeline accepts voice calls only, so she should use 911 instead
• d.She should email the counselor, who will reply the next business day

SAMHSA describes the 988 Suicide & Crisis Lifeline as free, confidential, and available 24 hours a day, 7 days a week, and states that it offers chat and text services for people who are deaf or hard of hearing. It can go on her safety plan. 988 is not voice-only and is not limited to business hours. An email answered the next business day is not a crisis resource. NIMH adds that 911 is for life-threatening situations.