NCMHCE Questions and Answers 5 — Questions and Answers
Question 1: A counselor working with a grieving client who lost her spouse 18 months ago notices the client continues to avoid reminders of the deceased and has withdrawn from all social activities. Which diagnosis should the counselor consider?
- Major Depressive Disorder, Single Episode
- Prolonged Grief Disorder (Correct answer)
- Adjustment Disorder with Depressed Mood
- Persistent Depressive Disorder (Dysthymia)
Correct answer: Prolonged Grief Disorder
Prolonged Grief Disorder is characterized by intense grief lasting more than 12 months with functional impairment, avoidance, and difficulty accepting the loss.
Question 2: In an NCMHCE simulation, a client with schizophrenia is stable on antipsychotics but resistant to attending group therapy. The counselor's BEST approach is:
- Require group participation as a condition of continued individual therapy
- Explore the client's specific concerns about group therapy before problem-solving (Correct answer)
- Accept the refusal and focus solely on individual therapy indefinitely
- Consult the prescribing physician to adjust medication to improve socialization
Correct answer: Explore the client's specific concerns about group therapy before problem-solving
Exploring the client's specific barriers to group therapy respects autonomy while identifying what might make group participation more acceptable.
Question 3: A counselor receives a subpoena for a client's therapy records in a custody dispute. What is the MOST appropriate initial action?
- Release records immediately to comply with the legal order
- Notify the client and consult with a legal professional before releasing records (Correct answer)
- Refuse to release records on the basis of therapeutic privilege
- Contact the court directly to request a records seal
Correct answer: Notify the client and consult with a legal professional before releasing records
A subpoena requires counselors to notify the client and seek legal guidance, as a subpoena alone does not override privilege without a court order.
Question 4: Which of the following NCMHCE simulation responses reflects accurate application of the DSM-5 criterion for Substance Use Disorder severity?
- Mild = 1-2 criteria, Moderate = 3-5 criteria, Severe = 6+ criteria (Correct answer)
- Mild = 2-3 criteria, Moderate = 4-5 criteria, Severe = 6+ criteria
- Severity is determined by frequency of use, not number of criteria
- Severity is clinician-rated on a 1-10 scale based on functional impairment
Correct answer: Mild = 1-2 criteria, Moderate = 3-5 criteria, Severe = 6+ criteria
DSM-5 specifies Substance Use Disorder severity as mild (2-3), moderate (4-5), and severe (6+) based on count of 11 diagnostic criteria.
Question 5: A counselor is planning termination with a client who has met all treatment goals but is anxious about ending. What is the MOST therapeutically appropriate response?
- Extend treatment until the client feels completely comfortable with termination
- Explore the client's anxiety about termination as part of the therapeutic work (Correct answer)
- Normalize the anxiety verbally and proceed with scheduled termination
- Transfer the client to a support group to ease the transition
Correct answer: Explore the client's anxiety about termination as part of the therapeutic work
Exploring termination anxiety therapeutically leverages the ending itself as an opportunity to practice coping with loss and transitions.
Question 6: During an NCMHCE simulation, a client discloses he is HIV-positive and is having unprotected sex with a partner who is unaware of his status. The counselor's BEST response is:
- Report the situation to public health authorities immediately
- Warn the identified third-party partner directly
- Explore the client's barriers to disclosure while assessing duty-to-protect obligations (Correct answer)
- Maintain strict confidentiality as the situation involves private health information
Correct answer: Explore the client's barriers to disclosure while assessing duty-to-protect obligations
The counselor must first explore disclosure barriers and state-specific duty-to-protect laws before determining the appropriate action.
Question 7: A client reports that antidepressants have eliminated her depressive symptoms but she now feels emotionally 'flat' and has no motivation. From a counseling perspective, the MOST appropriate next step is:
- Recommend that the client discontinue antidepressants and try therapy alone
- Document the report and continue current treatment without changes
- Explore the experience in depth and coordinate with the prescribing provider (Correct answer)
- Interpret the flatness as emotional avoidance and address it with cognitive techniques
Correct answer: Explore the experience in depth and coordinate with the prescribing provider
Emotional blunting is a recognized antidepressant side effect; coordinating with the prescriber while validating the client's experience is the appropriate integrated approach.
NCMHCE Questions and Answers 5
A counselor working with a grieving client who lost her spouse 18 months ago notices the client continues to avoid reminders of the deceased and has withdrawn from all social activities.
Which diagnosis should the counselor consider?