In January, I shared the experience that influenced me to pursue a career in counselor education with an emphasis on preparation for the National Clinical Mental Health Counseling Examination (NCMHCE). Since the article was published at CT Online, I have received many emails from interns with questions about the most effective ways to prepare for the NCMHCE and how to know when they’re ready to take the exam. This article is geared toward addressing these questions.


You thought the time would never actually come, but here it is: You’re ready to start preparing for the counselor licensure exam. Getting to this point in your career is an enormous accomplishment, but figuring out what to do in terms of adequately preparing for the NCMHCE can be quite confusing.

Some people wonder, “Do I really even need to study for the NCMHCE? I did pretty well in grad Abstract grunge rubber stamp set with the text Fail - Pass writtschool, so I’m sure this test will be a breeze.” I would like to kibosh this line of thinking right out of the gate and hopefully save you from losing the NCMHCE registration fee of between $100 and $195 (the fee is less for national certified counselors in good standing).

The NCMHCE covers content areas from assessment administration and treatment planning to supervision and group counseling theories. The format of the NCMHCE is unlike any test you have probably ever taken and, unfortunately, 40 to 45 percent of test-takers fail the exam. So, in short, yes, you do need to study for the NCMHCE. But with such a comprehensive examination, where do you begin?


Step 1: Determine if the NCMHCE is the required test for licensure in your state.

To do this, visit the National Board for Certified Counselors’ (NBCC) state board directory (, click on your state, and then look at “credentials” on the right side of your screen. This will tell you whether a passing score on the National Counselor Examination for Licensure and Certification (NCE) or the NCMHCE is required to become licensed.

If the NCMHCE is required, register to take your exam. This process takes time, so you’ll want to get the ball rolling right away. Also, know that you can postpone your test date to any day within your six-month eligibility period with no additional fees as long as you reschedule at least eight days prior to your originally scheduled test date. (See “Additional Information” on the NCMHCE Registration Form for more details:


Step 2: Start doing research on NCMHCE study materials.

There are lots of resources available to help you prepare for the NCMHCE, and some are better than others. Talk to NCMHCE test-preparation vendors at conferences about the materials they provide. Sign up for as many free resources and trials to different websites as possible so you can evaluate the content before actually spending your hard-earned money. See which study programs align best with your learning style.

Also, take a look at what is offered in the event that you don’t pass the NCMHCE the first time. Some websites offer a money-back guarantee, whereas others will renew your membership for free if you are unsuccessful on your exam attempt(s).


Step 3: Consult with your licensed colleagues.

Talk to your licensed colleagues about how they prepared for the NCMHCE. Ask them what they liked and didn’t like about the resources they used — and why. If you know anyone who failed the NCMHCE, ask them what they wish they had done differently when they were preparing.

Learning from those professionals who have already had some experience preparing for the NCMHCE may save you a headache in the long run.


Step 4: Become best friends with the DSM-5.

When I tell test-takers that they do need to memorize diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in order to successfully navigate through the NCMHCE, most react as if I have suggested that they move to a foreign country and learn six new languages. (The diagnostic criteria are the part in each section that look like an outline of symptoms.) This task feels overwhelming to many test-takers — something that can’t actually ever be accomplished.

Rest assured, it can be accomplished. As with anything new or daunting, how test-takers experience this task depends largely on their attitude. If you dread learning the DSM-5 material, the entire study process will probably feel like a tedious nightmare, and it’s likely you won’t even retain the information you’re studying, which means the nightmare will just drag on forever because you can’t pass this test without knowing this stuff.

See? Not a fun scenario. If, on the other hand, you approach this task as a challenge that you are eager to overcome because you know how important it is to be able to accurately diagnose or debate a possible misdiagnosis on behalf of your client(s), you will probably enjoy the experience and retain the material because you’re doing what you were made to do — work hard for the clients you serve and lead by example when it comes to tackling challenges with enthusiasm.

Sure, reading about the specifiers for bulimia nervosa may not be your favorite leisure activity, but it can be made fun, especially if you recruit members of your support system to join you in your efforts. Consider asking your partner or kids to quiz you on two disorders per day. Challenge yourself by trying to diagnose characters on your favorite TV shows or movies — think about Frank or Ian in Shameless, Tara in United States of Tara, Carrie in Homeland, Walter in Breaking Bad, etc. Even if your agency doesn’t require you to document diagnoses for your clients, formulate provisional diagnoses anyway. Weave the learning of DSM-5 diagnostic criteria into your daily life.

Just like with the NCMHCE study materials, many tools out there are designed to simplify the diagnoses in the DSM-5. Do some research and see which resources best align with your learning style.


Step 5: Plan study time in advance and stay accountable.

Don’t wait to see how your day goes before determining if and when you’re going to get any study time in. Instead, be proactive and plan your study time in advance. Think of it as time that you are unavailable for anything else, just like you would do if you were attending a class.

If you’re like many people, your professional and personal obligations will likely dictate your prescheduled study time. Consider a regimen such as one hour of DSM-5 review in the morning and one hour of working through practice simulations in the evening, or four straight hours of studying on a day when you may be off work. Perhaps your employer will allow you an hour or two of study time a few times per week to support you in your licensure efforts. Maybe you will have to schedule your study time on the weekends. Regardless of when you do your studying, make sure that you carve that time out in advance so that preparing for the NCMHCE is a priority rather than an afterthought.

Also, consider planning regular study groups with your colleagues or classmates who are also preparing for the NCMHCE. This type of support and accountability can make all of the difference in the way you experience this process.


Step 6: Take a prestudying baseline assessment of your readiness.

Before you get too heavily immersed in your studies, complete a practice simulation and rate your level of readiness as it relates to your ability to pass the NCMHCE on a scale of 1-10 (1 = you are nowhere near ready; 10 = you are totally ready — you could have passed the NCMHCE yesterday). This score will come in handy later.


Knowing when you’re ready

You’ve been eating, drinking and breathing nothing but NCMHCE test-preparation materials, and now you’re wondering if you can stop this madness and finally sit for the test.

Many test-takers ask me how long they should study before evaluating their readiness. The answer to this question really depends on how much time you are able to dedicate to preparing for the exam. Generally speaking, in my experience, the first-time test-takers who are most pleased with their performance on test day commit to consistent studying (two to three hours per day, five days a week) for about three months.

In determining your readiness, ask yourself the following questions.


1) What is your current readiness score?

As you’re preparing for the NCMHCE, you will experience a spectrum of emotions ranging from happiness to frustration and everything in between. You may even consider switching careers just to avoid the licensure exam. This process is rigorous, and it can push you to some pretty discouraging places. Throughout this studying endeavor, it’s easy to lose perspective and forget how much you’ve grown since you started all of this.

Remember your prestudying readiness score? It’s time to compare that score with how you’re feeling today. So, take a deep breath, complete a simulation you’ve never done before, and do a little self-assessment by rating your readiness on a scale of 1-10. Push yourself by exploring if your readiness score is based on the knowledge and skills you’ve developed during your studies or if it reflects any false sense of confidence.

If your score has increased, and if it reflects true confidence, this is an indicator that you are moving in the direction toward being ready.


2) How are you performing on practice tests with a series of 10 consecutive simulations?

Remember that the passing score needed on the NCMHCE is based on your cumulative performance. So, theoretically, you could do poorly on one simulation but really well on another simulation and still pass the NCMHCE. I advise test-takers that scoring around a 90 percent average in both the Decision-Making and Information-Gathering sections of a simulation is one quantitative indicator of readiness.

Although performance on a single simulation is important, an overall score based on a series of 10 consecutive simulations is even better (given that the NCMHCE has 10 simulations). I encourage test-takers to wait until they are a few weeks from their test date to begin completing a series of 10 consecutive simulations so they can truly assess the knowledge they have absorbed up until that point (doing this a total of three times, with a couple of days in between, is ideal).

It is really important to approach each of these three separate, 10-consecutive-simulation sessions as if they are the actual test. Block out three hours of uninterrupted time, try to complete the task during the time of day you intend to schedule your actual test, take breaks in the way you intend to for the real deal and pay close attention to how you’re feeling throughout the process.

This is a time to learn about yourself. Do you feel exhausted, as if you can’t go on after the third simulation? If so, tweak your approach next time. Do something like eating a granola bar right before you start the test and take breaks after simulations one and two to see if this helps to increase your stamina. Does your mind feel like mush at simulation 10? If so, try taking a five-minute break after simulation nine to see if it makes a difference.

Earning overall passing scores on each of the three 10-consecutive-simulation sessions is the most reliable quantitative method I use to determine a test-taker’s readiness. In more than four years, I have never had a test-taker fail these three 10-consecutive-simulation sessions and pass the actual NCMHCE.


3) Can you differentiate between disorders that have similar diagnostic criteria?

One of the many things the licensure exam measures throughout each simulation is your ability to narrow down a diagnosis. What this means is that you need to know when a client better meets the criteria for persistent depressive disorder than major depressive disorder, for example. Ask yourself questions such as: What separates oppositional defiant disorder from conduct disorder? How are bipolar I and bipolar II different? What questions do you need to ask to determine if a client is experiencing a phase-of-life problem or an adjustment disorder?

Being proficient in your ability to differentiate between disorders that have similar diagnostic criteria is another great indicator of your readiness to sit for the NCMHCE.


Tying it all together

When it comes to preparing for the NCMHCE, do your research about what study materials are going to be the most effective for you, and commit to the process. When it’s time to determine if you’re ready to sit for and pass the NCMHCE, do some critical self-exploration and measure your performance using practice tests.

If you still need to put more time into your studies before you feel confident enough to take the NCMHCE, no biggie; just consider postponing your exam date rather than going into the test feeling unprepared. Most important, use the support system around you — whether it’s your dog, your friend or your boss — and remember that everyone who cares about you wants to see you succeed.




Alyson Carr is a licensed mental health counselor with a doctorate in counselor education from the University of South Florida. Contact her through her website at




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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