The National Counselor Examination (NCE) Content Outline

Content Outline

The National Counselor Examination (NCE)

Exam Purpose

The National Counselor Examination (NCE) measures an examinee’s knowledge and

understanding of theoretical and skill-based tenets necessary to practice safely and

competently as an entry-level counselor. The exam’s development is based upon a national

job analysis of more than 16,000 credentialed counselors identifying empirically validated work

behaviors determined to be most relevant for competent counseling practice.

Measurement Focus and Target Population

The examination is aligned with the eight Council for Accreditation of Counseling and Related

Educational Programs (CACREP) content areas. Thus, the content validity of the NCE is

anchored on the six empirically validated work behaviors determined to be most relevant for

competent counseling practice and the eight CACREP curriculum educational standards. The

examinee target population is entry-level counselors with appropriate counseling training as

determined by the minimally qualied candidate requirements.

Minimally Qualiﬁed Candidate

The minimally qualied candidate (MQC) for the NCE has graduated from or is a well-advanced

graduate student in a counseling program* that has been accredited by CACREP or housed

within an institutionally accredited college or university.

The counseling program must contain courses in the following content areas:

• Professional Counseling Orientation and Ethical Practice

• Social and Cultural Diversity

• Human Growth and Development

• Career Development

• Counseling and Helping Relationships

• Group Counseling and Group Work

• Assessment and Testing

• Research and Program Evaluation

*States may choose to allow candidates of comparable education levels from other related

helping degrees to sit for the exam for licensure.

Exam Form

The NCE test comprises 200 multiple choice questions (MCQs), of which 160 are scored and 40

are unscored. These 40 MCQs provide statistical information for the items to be used in future

examinations. Both scored and unscored items are of the same structure, and they appear in

jumbled order in the examination. You will have 3 hours and 45 minutes to complete the test.

Job Analysis and Content Outline

The exam’s development is based upon a national job analysis of more than 16,000

credentialed counselors identifying empirically validated work behaviors determined to be most

relevant for competent counseling practice. The most recent job analysis was nalized in June

2019, with the content outline drafted and approved by the NCE Exam Committee, which is

comprised of Subject Matter Experts (SMEs).

The committee’s responsibilities included, but were not limited to, identifying components of

the profession and related job tasks and crafting survey items and reviewing the format of the

instrument to measure those components and tasks. Development of the job analysis survey

was completed at the Center for Credentialing & Education (CCE) over the course of one

calendar year (May 2016–July 2017).

The committee also evaluates the examination content for alignment with the eight CACREP

content areas following the creation of the content outline to provide valuable information to

examinees.

Table 1 presents the six domains and the percent and number of scored items in an NCE

examination on each of these domains.

Table 1. The weight for each domain

Domain Percent of items Number of scored items

1 Professional Practice and Ethics 12 19

2 Intake, Assessment, and Diagnosis 12 19

3 Areas of Clinical Focus 29 47

4 Treatment Planning 9 14

5 Counseling Skills and Interventions 30 48

6 Core Counseling Attributes 8 13

Total 100 160

Table 2 presents the knowledge, skills, and tasks under each domain of the Content Outline.

Table 2. Knowledge, skills, and tasks related to the domains.

1. Professional Practice and Ethics

This section encompasses counselors’ knowledge, skills, and abilities related to maintaining

proper administrative and clinical protocols.

A. Assess your (the counselor) competency to work with a specic client

B. Understand statistical concepts and methods in research

C. Practice legal and ethical counseling

D. Clarify counselor–client roles

E. Discuss client’s rights and responsibilities

F. Discuss limits of condentiality

G. Explain counselor agency policies

H. Review payment, fees, and insurance benets

I. Explain counseling processes, procedures, risks, and benets

J. Explain uses and limits of social media

K. Inform clients about the legal aspects of counseling

L. Obtain informed consent

M. Discuss condentiality as it applies to electronic communication

N. Establish group rules, expectations, and termination criteria

O. Assess competency to provide informed consent

P. Monitor the therapeutic relationship and build trust as needed

Q. Review client records

R. Provide adequate accommodations for clients with disabilities

S. Provide information to third parties

T. Provide referral sources if counseling services are inadequate/ inappropriate

U. Advocate for professional and client issues

V. Seek supervision/consultation

W. Create and maintain documentation appropriate for each aspect of the counseling process

X. Awareness and practice of self-care

2. Intake, Assessment, and Diagnosis

This section encompasses counselors’ knowledge, skills, and abilities to effectively conduct

client intake, assessment, and diagnosis.

A. Conduct a biopsychosocial interview

B. Conduct a diagnostic interview

C. Conduct cultural formulation interview

D. Conduct an initial interview

E. Determine diagnosis

F. Perform a Mental Status Exam (MSE)

G. Consider co-occurring diagnoses

H. Determine level of care needed

I. Determine the appropriate modality of treatment

J. Assess the presenting problem and level of distress

K. Evaluate an individual’s level of mental health functioning

L. Screen clients for appropriate services

M. Select, use, and interpret appropriate assessment instruments

N. Use formal and informal observations

O. Assess for trauma

P. Assess substance use

Q. Obtain client self-reports

R. Evaluate interactional dynamics

S. Conduct ongoing assessment for at-risk behaviors (i.e., suicide, homicide, self/other

injury, and relationship violence)

T. Use pre-test and post-test measures to assess outcomes

U. Evaluate counseling effectiveness

3. Areas of Clinical Focus

This section encompasses counselors’ knowledge and skills related to areas of clients’

concern(s).

A. Adjustment related to physical loss/injury/medical condition

B. Aging/geriatric concerns

C. Behavioral problems

D. Bullying

E. Caregiving concerns

F. Cultural adjustments

G. End-of-life issues

H. Fear and panic

I. Financial issues

J. Gender identity development

K. Grief/loss

L. Hopelessness/depression

M. Loneliness/attachment

N. Hyper/hypo mental focus

O. Intellectual functioning issues

P. Insomnia/sleep issues

Q. Maladaptive eating behaviors

R. Remarriage/recommitment

S. Developmental processes/tasks/issues

T. Obsessive thoughts/behaviors

U. Occupation and career development

V. Physical issues related to anxiety

W. Physical issues related to depression

X. Physical/emotional issues related to trauma

Y. Process addictions (pornography, gambling)

Z. Racism/discrimination/oppression

AA. Religious values conict

AB. Retirement concerns

AC. Ruminating and/or intrusive thoughts

AD. Separation from primary care givers

AE. Sexual functioning concerns

AF. Sleeping habits

AG. Spiritual/existential concerns

AH. Stress management

AI. Substance use/addiction issues

AJ. Suicidal thoughts/behaviors

AK. Terminal illness issues

AL. Visual/auditory hallucinations

AM. Worry and anxiety

AN. Adoption issues

AO. Blended family issues

AP. Child abuse-related concerns

AQ. Child development issues

AR. Dating/relationship problems

AS. Divorce

AT. Family abuse/violence (e.g., physical, sexual, emotional)

AU. Interpersonal partner violence concerns

AV. Marital/partner communication problems

AW. Parenting/co-parenting conicts

AX. Emotional dysregulation

4. Treatment Planning

This section encompasses counselors’ knowledge, skills, and abilities to develop an

effective course of treatment.

A. Collaborate with client to establish treatment goals and objectives

B. Establish short- and long-term counseling goals consistent with clients’ diagnoses

C. Identify barriers affecting client goal attainment

D. Identify strengths that improve the likelihood of goal attainment

E. Refer to different levels of treatment (e.g., outpatient, inpatient, residential, etc.)

F. Refer to others for concurrent treatment

G. Guide treatment planning

H. Discuss termination process and issues

I. Discuss transitions in group membership

J. Follow-up after discharge

K. Use assessment instrument results to facilitate client decision making

L. Review and revise the treatment plan

M. Engage clients in review of progress toward treatment goals

N. Collaborate with other providers and client support systems (documentation and report

writing)

O. Discuss with clients the integration and maintenance of therapeutic progress

P. Educate client to the value of treatment plan compliance

5. Counseling Skills and Interventions

This section encompasses counselors’ knowledge, skills, and abilities to conduct effective

counseling.

A. Align intervention with client’s developmental level

B. Align intervention with counseling modality (individual, couple, family, or group)

C. Align intervention with client population (e.g., veterans, minorities, disenfranchised,

disabled)

D. Implement individual counseling in relation to a plan of treatment

E. Establish therapeutic alliance

F. Apply theory-based counseling intervention(s)

G. Address addiction issues

H. Address cultural considerations

I. Address family composition and cultural considerations

J. Evaluate and explain systemic patterns of interaction

K. Explore family member interaction

L. Explore religious and spiritual values

M. Guide clients in the development of skills or strategies for dealing with their problems

N. Help clients develop support systems

O. Help facilitate clients’ motivation to make the changes they desire

P. Improve interactional patterns

Q. Provide crisis intervention

R. Educate client about transference and defense mechanisms

S. Facilitate trust and safety

T. Build communication skills

U. Develop conict resolution strategies

V. Develop safety plans

W. Facilitate systemic change

X. Provide distance counseling or telemental health

Y. Provide education resources (e.g., stress management, assertiveness training, divorce

adjustment)

Z. Provide psychoeducation for client

AA. Summarize

AB. Reframe/redirect

AC. Facilitate empathic responses

AD. Use self-disclosure

AE. Use constructive confrontation

AF. Facilitate awareness of here-and-now interactions

AG. Facilitate resolution of interpersonal conict

AH. Use linking and blocking in a group context

AI. Management of leader–member dynamics

AJ. Model giving and receiving of feedback

AK. Address impact of extended families

AL. Contain and manage intense feelings

AM. Explore the inuence of family of origin patterns and themes

AN. Address the impact of social support network

AO. Use “structured” activities

AP. Promote and encourage interactions among group members

AQ. Promote and encourage interactions with the group leader

AR. Use psychoeducation as a part of the group process

AS. Explain phases in the group process

AT. Identify and discuss group themes and patterns

AU. Create intervention based on the stage of group development

AV. Challenge harmful group member behaviors

AW. Address the potential interaction of members outside of the group

6. Core Counseling Attributes

This section encompasses behaviors, traits, and dispositions of effective counselors.

A. Awareness of self and impact on clients

B. Genuineness

C. Congruence

D. Demonstrate knowledge of and sensitivity to gender orientation and gender issues

E. Demonstrate knowledge of and sensitivity to multicultural issues

F. Demonstrate conict tolerance and resolution

G. Empathic attunement

H. Empathic responding

I. Foster the emergence of group therapeutic factors

J. Non-judgmental stance

K. Positive regard

L. Respect and acceptance for diversity

M. Use foundational listening, attending, and reecting skills

Table 3 presents the list of the eight common core areas by CACREP with which the

examination questions of the NCE are aligned.

Table 3. CACREP Common Core Areas

1. Professional counseling orientation and ethical practice

2. Social and cultural diversity

3. Human growth and development

4. Career development

5. Counseling and helping relationships

6. Group counseling and group work

7. Assessment and testing

8. Research and program evaluation