Sample practice questions

A few real questions from this free bank, with full explanations. Use the practice tool above for the whole set.

1. 1. Professional Practice and Ethics

   Maya, 19, has seen a counselor by video for six sessions for generalized anxiety disorder, the diagnosis given at intake. The counselor is licensed only in the state where Maya grew up. At session 7 Maya says she is moving next week to a university in another state and wants to keep meeting by video from her dorm. She is doing well and asks whether anything needs to change. What should the counselor do FIRST?

   • a.End services the day she moves and name a campus center
   • b.Switch to text messaging, which is not regulated as counseling
   • c.Continue as before; the license travels with the counselor
   • d.Check whether the counselor can legally practice in Maya's new state

   Answer: d

   Explanation: Both codes place telehealth under the law of the client's location as well as the counselor's: NBCC standard 92 requires counselors to follow the legal requirements of the state(s) where counselor and client are located, and ACA H.1.b says clients must know the rules for counseling across state lines. A license does not travel with the counselor. Ending services abruptly the day she moves skips pretermination planning, and changing to text messages does not remove the legal question, because it is still counseling.

2. 2. Professional Practice and Ethics

   A counselor whose spouse died 3 weeks ago has returned to a full caseload. Several clients are working on grief after deaths in their families. In two recent sessions the counselor started crying and lost track of what the client was saying, and has been sleeping poorly. What is the counselor's ethical obligation?

   • a.Seek help and reduce or pause grief work until able to practice safely
   • b.Tell grieving clients about the loss so they understand the counselor's tears
   • c.Keep seeing all clients, since sharing grief can strengthen the relationship
   • d.Keep the full caseload and take extra time off only if a client complains

   Answer: a

   Explanation: ACA C.2.g asks counselors to watch for signs of impairment from their own emotional problems, to seek help, and if necessary to limit, suspend, or end professional duties until they can safely resume. NBCC standard 4 likewise requires seeking assistance or withdrawing from practice when one's condition prevents appropriate services. Losing track of sessions is a sign of impairment, not a relationship tool. Turning the session toward the counselor's loss puts the counselor's needs ahead of the client's. Waiting for complaints puts the burden on clients.

3. 3. Intake, Assessment, and Diagnosis

   Luis, 47, a small-business owner, says he has 'worried about everything' for about 7 months: money, his children's safety, his health, and customers' reviews. He cannot stop the worry, feels on edge, has tense shoulders, is tired, and wakes at 3 a.m. He has had no sudden attacks of intense fear and does not avoid social situations. Which diagnosis BEST fits?

   • a.Social anxiety disorder
   • b.Obsessive-compulsive disorder
   • c.Generalized anxiety disorder
   • d.Panic disorder

   Answer: c

   Explanation: NIMH says GAD requires difficulty controlling worry on most days for at least 6 months, with at least three symptoms such as restlessness, fatigue, muscle tension, or sleep problems. Luis has 7 months of widespread, uncontrollable worry with four such symptoms. Panic disorder requires recurrent unexpected panic attacks, which he denies. Social anxiety centers on fear of being judged in social situations. OCD involves intrusive obsessions and repetitive compulsions, not general worry about many life areas.

4. 4. Intake, Assessment, and Diagnosis

   At intake, Paul, 52, lists several things from his history: he lost his job last year, lives alone, drinks four or five beers most nights, his uncle died by suicide, and he took an overdose of pills 6 years ago during his divorce. He currently denies suicidal thoughts. According to SAMHSA's TIP 50, which item in his history is the MOST potent risk factor for eventual suicide?

   • a.His uncle's death by suicide
   • b.The job loss last year
   • c.The overdose 6 years ago
   • d.Living alone

   Answer: c

   Explanation: TIP 50 lists a prior history of suicide attempts as the most potent risk factor, while noting that about half of deaths by suicide are first attempts. Family history of suicide, job loss, social isolation, and heavy substance use are also listed risk factors and matter in his overall picture, but none is described as stronger than a past attempt. His current denial of suicidal thoughts does not erase this long-term risk, and his history should be monitored throughout treatment.

5. 5. Intake, Assessment, and Diagnosis

   Walt, 39, meets criteria for alcohol use disorder, moderate. He has had no withdrawal symptoms, has no medical or psychiatric complications, lives with a supportive spouse, wants to keep his job, and is ready to change. His employer's assistance program suggests 'a 30-day residential program because he has a diagnosis.' According to the ASAM Criteria principles, how should his level of care be determined?

   • a.From the length of stay the employer's program usually approves
   • b.From the diagnosis alone, because moderate AUD requires residential treatment
   • c.By a multidimensional assessment, using the least intensive safe setting
   • d.From his preference alone, regardless of his risk in any dimension

   Answer: c

   Explanation: The ASAM Criteria materials stress that a diagnosis is necessary but not sufficient to decide level of care. Placement comes from a multidimensional assessment of severity and functioning, delivered in the least intensive but safe setting, and fixed-length programs are criticized as program-driven rather than client-driven. Walt shows little risk across dimensions, which points to an outpatient level. Diagnosis alone, a usual length of stay, or client preference that ignores risk do not follow the model.

6. 6. Treatment Planning

   A counselor runs a revolving-membership relapse-prevention group for adults with substance use disorders. A new client, Lionel, 44, whose intake diagnosis is alcohol use disorder, moderate, is scheduled to join next week. Some current members have said they dislike 'newcomers who don't know the rules.' What should the counselor do BEFORE Lionel's first group?

   • a.Meet with Lionel individually to review the group agreement
   • b.Have Lionel observe one session silently before participating
   • c.Delay Lionel's entry until the current members agree to accept him
   • d.Let the group explain the rules to Lionel during his first session

   Answer: a

   Explanation: TIP 41 describes the pregroup interview as the time when the leader meets individually with each prospective member to begin an alliance, explain what group therapy involves, ease anxiety, and review the group agreement. It notes that accepting the agreement before entering is a major contributor to group success. Leaving orientation to members puts the leader's job on them. Letting members veto a new member, or having him sit silently, is not part of the TIP's approach to managing transitions in group membership.

7. 7. Counseling Skills and Interventions

   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

   Answer: d

   Explanation: 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.

8. 8. Counseling Skills and Interventions

   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

   Answer: d

   Explanation: 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.

9. 9. Counseling Skills and Interventions

   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."

   Answer: a

   Explanation: 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.

10. 10. Core Counseling Attributes

    A newly licensed counselor whose brother died by suicide notices feeling panicky and wanting to change the subject whenever clients mention suicidal thoughts. Yesterday the counselor rushed past a client's comment that 'my family would do fine without me around.' What does SAMHSA's TIP 50 recommend?

    • a.Share the brother's story with clients so they know the counselor understands
    • b.Stop asking about suicide, since the counselor's discomfort may upset clients
    • c.Avoid suicidal clients by referring all of them to other counselors
    • d.Complete a personal suicide attitude inventory and explore it in supervision

    Answer: d

    Explanation: TIP 50 advises counselors to take a suicidal attitude inventory, looking at personal and family history with suicide and their emotional reactions, not to change their views but to understand how those views affect their work with clients, and to clarify them through clinical supervision or peer consultation. A negative or avoidant attitude can lead to missed chances to help, as happened yesterday. Referring all such clients elsewhere or not asking about suicide leaves risk unaddressed. Sharing the loss centers the counselor's experience.