National Counselor Examination (NCE) — Questions and Answers

Question 1: The concept of 'familismo' in Latino/Hispanic culture refers to:

Strong family loyalty, solidarity, and obligation among family members (Correct answer)
The role of the Catholic Church in family decision-making
The patriarchal authority structure in Hispanic families
Traditional gender roles assigned within the Hispanic family unit

Correct answer: Strong family loyalty, solidarity, and obligation among family members

Familismo describes strong feelings of loyalty, reciprocity, and solidarity with immediate and extended family members that are central to Latino cultural identity.

Question 2: The level of care a client needs for substance use treatment is most commonly determined using:

ASAM Criteria (Correct answer)
Holland Codes
The Myers-Briggs Type Indicator
Erikson's psychosocial stages

Correct answer: ASAM Criteria

The ASAM Criteria use multidimensional assessment to match clients to the right level of care.

Question 3: In the 4 P's model of case conceptualization, which factor refers to influences that maintain a client's problem over time?

Protective
Predisposing
Precipitating
Perpetuating (Correct answer)

Correct answer: Perpetuating

Perpetuating factors are the conditions that keep the problem going once it has started.

Question 4: Which of the following best describes 'scaffolding' in Vygotsky's theory?

Support provided within a child's Zone of Proximal Development (Correct answer)
Peer conflict resolution
Punishment used to shape behavior
Cognitive schema formation

Correct answer: Support provided within a child's Zone of Proximal Development

Scaffolding involves providing temporary support that is gradually withdrawn as the learner gains competence, operating within the Zone of Proximal Development (ZPD).

Question 5: Vocational Rehabilitation (VR) services in the U.S. are administered primarily through:

The Veterans Administration
Nonprofit disability organizations
The Social Security Administration
State VR agencies funded by federal-state partnerships (Correct answer)

Correct answer: State VR agencies funded by federal-state partnerships

VR services in the U.S. are provided by state VR agencies operating under federal-state partnerships authorized by the Rehabilitation Act, helping individuals with disabilities achieve employment goals.

Question 6: In Bowen family systems theory, which concept describes the ability to keep one's own thinking separate from family emotional pressure?

Triangulation
Differentiation of self (Correct answer)
Family projection process
Emotional cutoff

Correct answer: Differentiation of self

Differentiation of self is the ability to separate thoughts from emotions and self from others in the family.

Question 7: A counselor is working with a client who has just experienced a natural disaster. Which approach is most appropriate in the immediate aftermath?

Detailed trauma narrative processing
Intensive psychoanalysis
Psychological first aid (Correct answer)
Long-term exposure therapy

Correct answer: Psychological first aid

Psychological first aid focuses on safety, comfort, practical assistance, and connection to resources in the immediate aftermath. Deeper trauma processing is generally delayed until the person is stabilized.

Question 8: In Cognitive-Behavioral Therapy (CBT), what are the automatic negative thoughts called that distort reality?

Cognitive distortions (Correct answer)
Schemas
Defense mechanisms
Core beliefs

Correct answer: Cognitive distortions

Cognitive distortions are irrational thought patterns identified in CBT that negatively bias perception and contribute to emotional distress.

Question 9: Tiedeman and O'Hara's decision-making model divides career decisions into two broad phases. What are they?

Exploration and establishment
Circumscription and compromise
Fantasy and realism
Anticipation (preoccupation) and implementation (adjustment) (Correct answer)

Correct answer: Anticipation (preoccupation) and implementation (adjustment)

Tiedeman and O'Hara described an anticipation phase (exploration, crystallization, choice, clarification) followed by an implementation phase (induction, reformation, integration).

Question 10: Intersectionality, as introduced by Kimberlé Crenshaw, is most relevant in counseling because it:

Recognizes that multiple social identities interact to create unique experiences of privilege and oppression (Correct answer)
Explains how cognitive distortions intersect with emotional responses
Outlines the intersection of individual and systemic factors in career development
Describes how different therapeutic modalities can be combined effectively

Correct answer: Recognizes that multiple social identities interact to create unique experiences of privilege and oppression

Intersectionality recognizes that clients hold multiple identities (race, gender, class, sexuality) that overlap and interact, creating unique experiences that cannot be understood by examining each identity in isolation.

Question 11: Practitioners who systematically study and improve their own counseling practice within their setting are conducting:

Ex post facto research
Longitudinal survey research
Meta-analysis
Action research (Correct answer)

Correct answer: Action research

Action research is practitioner-led inquiry aimed at solving local problems and improving practice.

Question 12: A school counselor working under FERPA is asked by a non-custodial parent for their child's educational records. Absent a court order restricting access, what applies?

The non-custodial parent generally has the same right as a custodial parent to inspect educational records (Correct answer)
Only the student may approve the release at any age
Records may only be released to the custodial parent's attorney
The non-custodial parent has no rights to the records

Correct answer: The non-custodial parent generally has the same right as a custodial parent to inspect educational records

FERPA gives both parents access rights unless a court order, statute, or legal document specifically revokes them.

Question 13: Psychodrama was developed by which theorist?

Carl Rogers
Jacob Moreno (Correct answer)
Fritz Perls
William Schutz

Correct answer: Jacob Moreno

Jacob Moreno developed psychodrama, a group modality using role-playing, improvisation, and dramatic action to explore emotional and interpersonal issues.

Question 14: Which assessment tool would best help a counselor conceptualize multigenerational family patterns?

Beck Depression Inventory-II
MMPI-3
Strong Interest Inventory
Genogram (Correct answer)

Correct answer: Genogram

A genogram maps family relationships and patterns across at least three generations.

Question 15: Which measure of central tendency is most appropriate for a distribution of income data that includes a few extremely high outliers?

Range
Mean
Standard deviation
Median (Correct answer)

Correct answer: Median

The median is resistant to outliers and better represents the center of a skewed distribution. The mean is pulled toward extreme values. Range and standard deviation measure variability, not central tendency.

Question 16: A trauma counselor begins to view the world as dangerous and has trouble trusting others after years of hearing clients' trauma stories. This best describes:

Burnout
Compassion satisfaction
Vicarious trauma (Correct answer)
Countertransference

Correct answer: Vicarious trauma

Vicarious trauma involves lasting shifts in a helper's beliefs and worldview caused by cumulative exposure to clients' trauma.

Question 17: A dual relationship in counseling refers to:

Co-counseling with another therapist
Using two different theoretical orientations with one client
A counselor having multiple professional and personal roles with the same client (Correct answer)
Counseling two clients in the same family simultaneously

Correct answer: A counselor having multiple professional and personal roles with the same client

A dual (or multiple) relationship occurs when a counselor holds two or more roles simultaneously with a client — such as therapist and friend, employer, or instructor — creating a risk of harm or exploitation.

Question 18: Piaget's Formal Operational stage begins at approximately what age?

7 years
11–12 years (Correct answer)
18 years
2 years

Correct answer: 11–12 years

Piaget's Formal Operational stage begins around age 11–12, when children develop the ability to think abstractly and reason about hypothetical situations.

Question 19: Which concept refers to the unearned social privileges that members of a dominant group receive simply by belonging to that group?

White privilege (Correct answer)
Acculturation advantage
Social capital
Intersectionality

Correct answer: White privilege

White privilege, as articulated by Peggy McIntosh, refers to the largely invisible advantages and benefits that white individuals receive in a racially stratified society without having earned them.

Question 20: An older adult deliberately shrinks her social circle to a few close, emotionally meaningful relationships. Which theory best explains this?

Disengagement theory
Attachment theory
Social learning theory
Socioemotional selectivity theory (Correct answer)

Correct answer: Socioemotional selectivity theory

Carstensen's theory holds that as perceived time grows shorter, people put emotionally meaningful goals and relationships first.

Question 21: Affirmative therapy with LGBTQ+ clients is characterized by:

Remaining neutral about the client's sexual orientation or gender identity
Focusing only on presenting problems unrelated to sexual orientation
Actively validating and supporting LGBTQ+ identities as healthy variations (Correct answer)
Encouraging exploration of whether the identity can be changed

Correct answer: Actively validating and supporting LGBTQ+ identities as healthy variations

Affirmative therapy explicitly validates LGBTQ+ identities as normal and healthy variations of human experience and addresses minority stress and stigma that clients may experience.

Question 22: In Tuckman's model, the stage when members argue over control and push back against the leader is:

Forming
Performing
Norming
Storming (Correct answer)

Correct answer: Storming

Storming is marked by conflict, power struggles, and resistance as members test limits.

Question 23: A leader says, 'I notice the room got very quiet right after Maria mentioned her divorce.' The leader is focusing on:

Process (Correct answer)
Interpretation of the past
Content
Diagnosis

Correct answer: Process

Commenting on how members are interacting in the here-and-now is a process observation, not a discussion of content.

Question 24: Anne Roe's personality theory of career choice proposed that occupational orientation is shaped mainly by:

Personality fit with work environments
Stages of ego identity development
Early parent-child relationships and need satisfaction (Correct answer)
Chance events and learning experiences

Correct answer: Early parent-child relationships and need satisfaction

Roe argued that early parental climates (acceptance, avoidance, emotional concentration) steer people toward person-oriented or non-person-oriented work.

Question 25: Which term refers to a client needing increasingly larger amounts of a substance to achieve the same effect?

Withdrawal
Cross-dependence
Relapse
Tolerance (Correct answer)

Correct answer: Tolerance

Tolerance is a diminished response to the same dose over time, or the need for more of a substance to achieve the desired effect. It is one of the DSM criteria for substance use disorders.

Question 26: The ACA Code of Ethics was most recently revised in:

2023
2014 (Correct answer)
2010
2005

Correct answer: 2014

The ACA Code of Ethics was most recently revised in 2014, addressing issues such as technology, social media, distance counseling, and end-of-life care.

Question 27: According to Bronfenbrenner's ecological model, the 'microsystem' refers to:

The immediate settings in which a person lives (Correct answer)
Links between family and school
Cultural values and beliefs
Temporal changes over a lifetime

Correct answer: The immediate settings in which a person lives

The microsystem is the innermost level in Bronfenbrenner's model, encompassing the direct environments a person interacts with, such as family, school, and peers.

Question 28: In group development, Tuckman's model begins with which stage?

Storming
Performing
Forming (Correct answer)
Norming

Correct answer: Forming

Tuckman's model begins with the Forming stage, during which members are oriented, anxious, and dependent on the leader for structure and direction.

Question 29: Which instrument is most commonly used to rate the severity of alcohol withdrawal and guide medication dosing?

SASSI-4
COWS
ASI
CIWA-Ar (Correct answer)

Correct answer: CIWA-Ar

The Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar), scores alcohol withdrawal symptoms to guide symptom-triggered treatment.

Question 30: A qualitative researcher asks participants to review the preliminary themes to confirm they accurately reflect their experiences. This strategy is called:

Peer debriefing
Audit trail
Negative case analysis
Member checking (Correct answer)

Correct answer: Member checking

Member checking enhances credibility by having participants verify the researcher's interpretations.

Question 31: Which medication rapidly reverses an opioid overdose and is available over the counter as a nasal spray in the U.S.?

Clonidine
Naloxone (Correct answer)
Methadone
Flumazenil

Correct answer: Naloxone

Naloxone is a short-acting opioid antagonist that reverses respiratory depression, and the FDA approved OTC nasal naloxone in 2023.

Question 32: Structural Family Therapy, associated with Salvador Minuchin, focuses on which element?

Communication patterns and double binds
Family subsystems, boundaries, and hierarchies (Correct answer)
Multigenerational patterns
Solution exceptions and scaling questions

Correct answer: Family subsystems, boundaries, and hierarchies

Structural Family Therapy examines and restructures family organization, including subsystems (spousal, parental, sibling) and the boundaries between them.

Question 33: Which of the following is the best-written measurable treatment goal?

The client will try harder to relax
The client will reduce panic attacks from 5 per week to 1 per week within 8 weeks (Correct answer)
The client will feel better
The client will understand her anxiety

Correct answer: The client will reduce panic attacks from 5 per week to 1 per week within 8 weeks

Effective goals are specific, measurable, achievable, relevant, and time-bound. The correct option states a behavior, a baseline and target, and a timeframe.

Question 34: Within the SOAP note format, where does the counselor record the plan for the next session?

O
A
P (Correct answer)
S

Correct answer: P

The P section documents the plan, including next steps and interventions.

Question 35: What is the minimum duration of a hypomanic episode in DSM-5-TR?

2 consecutive days
14 consecutive days
4 consecutive days (Correct answer)
7 consecutive days

Correct answer: 4 consecutive days

A hypomanic episode needs at least 4 consecutive days, compared with 1 week for a manic episode.

Question 36: Erikson's stage of 'Identity vs. Role Confusion' occurs during which developmental period?

Early childhood
Early adulthood
Adolescence (Correct answer)
Middle childhood

Correct answer: Adolescence

Erikson's fifth psychosocial stage, Identity vs. Role Confusion, occurs during adolescence (ages 12–18) as individuals explore who they are.

Question 37: A client believes a coworker's bad mood must be due to something the client did. According to Beck, which cognitive distortion is this?

Overgeneralization
Personalization (Correct answer)
Magnification
Dichotomous thinking

Correct answer: Personalization

Personalization means attributing external events to oneself without evidence.

Question 38: A counselor openly invites a client to talk about how race may affect the presenting concern and the counseling relationship. Day-Vines and colleagues call this practice:

Broaching (Correct answer)
Bracketing
Immediacy
Cultural matching

Correct answer: Broaching

Broaching means the counselor deliberately starts a discussion of racial and cultural factors in counseling.

Question 39: Cronbach's alpha is most commonly used to estimate:

Alternate-forms reliability
Internal consistency reliability (Correct answer)
Predictive validity
Content validity

Correct answer: Internal consistency reliability

Cronbach's alpha estimates how consistently items on a scale measure the same construct.

Question 40: CACREP accreditation standards are relevant to counseling programs because they:

Establish minimum curricular and clinical training standards for graduate programs (Correct answer)
Approve billing codes for insurance reimbursement
Certify individual counselors for licensure
Govern state licensing examination content

Correct answer: Establish minimum curricular and clinical training standards for graduate programs

CACREP (Council for Accreditation of Counseling and Related Educational Programs) sets standards for graduate counseling training programs, ensuring graduates receive comprehensive preparation.

Question 41: A new measure of social anxiety correlates very weakly with a measure of mathematical ability. This finding provides evidence of what?

Convergent validity
Discriminant (divergent) validity (Correct answer)
Content validity
Concurrent validity

Correct answer: Discriminant (divergent) validity

Discriminant validity is shown when a measure correlates weakly with measures of theoretically unrelated constructs.

Question 42: A researcher examines whether gender is related to preference for individual versus group counseling, using frequency counts. Which test fits best?

Chi-square test of independence (Correct answer)
Paired samples t-test
Pearson r
ANCOVA

Correct answer: Chi-square test of independence

Chi-square tests whether two categorical (nominal) variables are associated using frequency data.

Question 43: Holland's RIASEC model categorizes personality types and environments into how many types?

8
4
5
6 (Correct answer)

Correct answer: 6

Holland's RIASEC model identifies six types: Realistic, Investigative, Artistic, Social, Enterprising, and Conventional, applicable to both people and work environments.

Question 44: Krumboltz's Social Learning Theory of Career Decision Making emphasizes which factors?

Personality type and environment congruence
Developmental stages and life roles
Genetic endowment and learning experiences (Correct answer)
Self-efficacy beliefs and outcome expectations only

Correct answer: Genetic endowment and learning experiences

Krumboltz identified four factors influencing career decisions: genetic endowments, environmental conditions, learning experiences, and task approach skills.

Question 45: The Strong Interest Inventory (SII) is based primarily on which theory?

Roe's personality theory
Holland's RIASEC typology (Correct answer)
Super's Life-Span theory
Krumboltz's Social Learning Theory

Correct answer: Holland's RIASEC typology

The Strong Interest Inventory organizes results using Holland's six RIASEC themes to match client interests with occupational environments.

Question 46: A counselor records a client's panic attacks during baseline, introduces treatment, withdraws it, and then reintroduces it. Which single-case design is this?

Multiple baseline design
ABAB (reversal) design (Correct answer)
Changing criterion design
AB design

Correct answer: ABAB (reversal) design

Alternating baseline and treatment phases twice is an ABAB reversal or withdrawal design.

Question 47: In the Racial/Cultural Identity Development model (Atkinson, Morten, and Sue), the first stage is marked by preference for dominant-culture values and depreciation of one's own group. This stage is:

Introspection
Dissonance
Resistance and immersion
Conformity (Correct answer)

Correct answer: Conformity

Conformity is the first stage, in which the person prefers dominant-culture values and devalues their own group.

Question 48: A former client sends a friend request to her counselor's personal social media account. According to the ACA Code of Ethics, what should the counselor do?

Accept it but limit what the client can see
Accept it only if the client has been out of treatment for 2 years
Decline, keeping personal and professional virtual presences separate (Correct answer)
Accept it, since the counseling relationship has ended

Correct answer: Decline, keeping personal and professional virtual presences separate

The ACA Code (H.6) says counselors should keep separate professional and personal social media profiles and should not set up personal virtual relationships with clients.

Question 49: A counselor who holds implicit biases toward clients from a certain cultural group should primarily:

Disclose the bias to the client at the start of the therapeutic relationship
Avoid working with clients from that cultural group entirely
Refer all clients from that group to a counselor from the same cultural background
Engage in ongoing self-examination, supervision, and continuing education to address the bias (Correct answer)

Correct answer: Engage in ongoing self-examination, supervision, and continuing education to address the bias

Ethical multicultural practice requires counselors to engage in ongoing self-reflection and use supervision and education to recognize and address biases rather than avoiding entire populations.

Question 50: A patient taking prescribed opioids exactly as directed develops tolerance and withdrawal. How are these symptoms handled when diagnosing opioid use disorder under DSM-5-TR?

They are counted only if the patient is over 65
They count double toward severity
They automatically confirm a severe diagnosis
They are not counted toward the diagnosis (Correct answer)

Correct answer: They are not counted toward the diagnosis

Tolerance and withdrawal that occur solely under appropriate medical supervision are excluded from the SUD criteria count.

Question 51: Brief psychotic disorder requires psychotic symptoms lasting how long?

At least 2 weeks
At least 1 month but less than 6 months
At least 1 day but less than 1 month (Correct answer)
At least 1 week but less than 6 months

Correct answer: At least 1 day but less than 1 month

Brief psychotic disorder lasts from 1 day up to less than 1 month, followed by a full return to prior functioning.

Question 52: Which of the following is NOT a recognized exception to client confidentiality?

Duty to warn an identifiable third party
Mandatory child abuse reporting
Court-ordered disclosure
Client's insurance company requests records for billing (Correct answer)

Correct answer: Client's insurance company requests records for billing

An insurance company requesting records for billing purposes does not automatically override confidentiality; client authorization is typically required before releasing records to third-party payers.

Question 53: Under the ACA Code of Ethics, a counselor may break confidentiality with a suicidal client when:

Disclosure is required to protect clients from serious and foreseeable harm (Correct answer)
A family member requests information
The counselor feels uncomfortable with the client's disclosures
The client misses two consecutive sessions

Correct answer: Disclosure is required to protect clients from serious and foreseeable harm

ACA Standard B.2.a allows disclosure when necessary to protect clients or others from serious and foreseeable harm.

Question 54: When a counselor uses a test without a client's informed consent, this violates:

The ACA Code of Ethics and testing ethical standards (Correct answer)
Only state licensure laws
Beneficence and competence only
Only HIPAA regulations

Correct answer: The ACA Code of Ethics and testing ethical standards

The ACA Code of Ethics requires informed consent for assessment, including explaining the purpose, nature, and use of results before testing begins.

Question 55: In Helms's White Racial Identity model, a person who intellectually accepts racism as real but still expects people of color to explain it is most likely in which status?

Disintegration
Contact
Pseudo-independence (Correct answer)
Autonomy

Correct answer: Pseudo-independence

Pseudo-independence involves intellectual acceptance of racism while still looking to people of color to resolve it.

Question 56: The 'working stage' of a group is characterized by:

High anxiety and resistance to disclosure
Cohesion, productivity, and deep self-disclosure (Correct answer)
Conflict between members and the leader
Preparation for termination

Correct answer: Cohesion, productivity, and deep self-disclosure

In the working stage, the group achieves cohesion, members engage in meaningful self-disclosure, and significant therapeutic work occurs.

Question 57: Super's Career Development Theory describes career development as a process spanning:

Retirement and late adulthood only
Ages 25–45
Only adolescence and early adulthood
The entire lifespan (Correct answer)

Correct answer: The entire lifespan

Donald Super proposed that career development is a lifelong process involving five stages: growth, exploration, establishment, maintenance, and decline/disengagement.

Question 58: Exposure to a teratogen is most likely to cause major structural birth defects during which prenatal period?

Embryonic period (weeks 3-8) (Correct answer)
Fetal period (weeks 9-38)
Germinal period (weeks 1-2)
Third trimester only

Correct answer: Embryonic period (weeks 3-8)

Major organs form during the embryonic period, which makes it the most critical window for structural defects.

Question 59: Which stage of the Transtheoretical Model is characterized by a client who is not yet considering changing their substance use?

Preparation
Action
Precontemplation (Correct answer)
Contemplation

Correct answer: Precontemplation

In precontemplation, the person is not intending to change in the foreseeable future and may be unaware of or deny the problem.

Question 60: An aging pianist plays fewer pieces, practices them more, and slows down before fast passages so they seem quicker. This illustrates:

Continuity theory
Activity theory
Selective optimization with compensation (Correct answer)
Disengagement theory

Correct answer: Selective optimization with compensation

Baltes's SOC model describes selecting goals, optimizing resources, and compensating for losses.

Question 61: Under 42 CFR Part 2, when may SUD treatment information be disclosed without the client's written consent?

To any law enforcement officer who asks verbally
To a family member who calls the program
To an employer asking about attendance
To medical personnel during a bona fide medical emergency (Correct answer)

Correct answer: To medical personnel during a bona fide medical emergency

Part 2 allows disclosure without consent to medical personnel when needed to treat a bona fide medical emergency.

Question 62: In stepped care, a client with mild depression would most likely begin with:

Low-intensity interventions such as guided self-help (Correct answer)
Electroconvulsive therapy
Intensive outpatient programming
Inpatient hospitalization

Correct answer: Low-intensity interventions such as guided self-help

Stepped care starts with the least intensive effective treatment and steps up only if needed.

Question 63: A client with long-term heavy alcohol use shows confusion, ataxia, and abnormal eye movements. Which deficiency is most likely?

Thiamine (vitamin B1) (Correct answer)
Folate
Vitamin D
Vitamin B12

Correct answer: Thiamine (vitamin B1)

These signs are the classic triad of Wernicke encephalopathy, which is caused by thiamine deficiency and is treated urgently with thiamine.

Question 64: A client experiences a persistent pattern of grandiosity, need for admiration, and lack of empathy beginning in early adulthood. Which diagnosis best fits?

Histrionic personality disorder
Antisocial personality disorder
Narcissistic personality disorder (Correct answer)
Borderline personality disorder

Correct answer: Narcissistic personality disorder

Narcissistic personality disorder is characterized by grandiosity, a need for admiration, and lack of empathy. These traits distinguish it from the other Cluster B disorders.

Question 65: When a client with co-occurring depression and alcohol use disorder seeks counseling, current best practice recommends:

Integrated treatment that addresses both conditions concurrently (Correct answer)
Treating depression only after six months of sobriety
Referring out for the alcohol use and ignoring it
Treating alcohol use only

Correct answer: Integrated treatment that addresses both conditions concurrently

Integrated treatment of co-occurring disorders produces better outcomes than sequential or parallel approaches.

Question 66: Dawis and Lofquist's Theory of Work Adjustment (TWA) focuses on:

Narrative life themes in career stories
The correspondence between individual needs and work environment reinforcers (Correct answer)
Developmental career stages
Self-efficacy in occupational tasks

Correct answer: The correspondence between individual needs and work environment reinforcers

TWA proposes that job satisfaction and tenure depend on the correspondence between a worker's needs and the reinforcers provided by the work environment.

Question 67: In psychoanalytic theory, which defense mechanism involves attributing one's own unacceptable feelings to others?

Projection (Correct answer)
Sublimation
Repression
Rationalization

Correct answer: Projection

Projection involves unconsciously attributing one's own unacceptable impulses or feelings to another person.

Question 68: A child correctly says two rows of coins have the same number even after one row is spread out. According to Piaget, this ability typically emerges in which stage?

Formal operational
Preoperational
Sensorimotor
Concrete operational (Correct answer)

Correct answer: Concrete operational

Conservation is a hallmark of the concrete operational stage, roughly ages 7 to 11.

Question 69: Which ethical principle refers to the counselor's obligation to 'do no harm'?

Beneficence
Justice
Fidelity
Nonmaleficence (Correct answer)

Correct answer: Nonmaleficence

Nonmaleficence is the obligation to avoid actions that cause harm to clients, and is one of the six foundational ethical principles outlined in the ACA Code of Ethics.

Question 70: Object relations theory emphasizes the impact of:

Neurotransmitter imbalances
Rational-emotive belief systems
Early relationships and internalized representations of self and others (Correct answer)
Operant conditioning on behavior

Correct answer: Early relationships and internalized representations of self and others

Object relations theory holds that early relational experiences create internalized mental representations ('objects') that shape how a person relates to others throughout life.

Question 71: Confidentiality in group counseling is more complex than in individual counseling because:

Group records are subject to mandatory disclosure
Members do not need to sign informed consent
The counselor cannot guarantee that all members will maintain confidentiality (Correct answer)
Group leaders are exempt from confidentiality laws

Correct answer: The counselor cannot guarantee that all members will maintain confidentiality

Unlike individual therapy, the group counselor cannot guarantee confidentiality because the counselor cannot control member behavior outside the group.

Question 72: A Gestalt counselor asks a grieving client to speak to a deceased parent as if the parent were sitting across the room. What is the primary goal?

Testing irrational beliefs
Resolving unfinished business (Correct answer)
Building a fear hierarchy
Interpreting transference

Correct answer: Resolving unfinished business

The empty-chair technique helps clients express unresolved feelings and complete unfinished business.

Question 73: Solution-Focused Brief Therapy (SFBT) uses the 'miracle question' to do what?

Explore past trauma
Help clients envision a future without the problem (Correct answer)
Analyze unconscious content
Identify cognitive distortions

Correct answer: Help clients envision a future without the problem

The miracle question invites clients to imagine waking up to find their problem solved, helping them articulate concrete goals and recognize existing strengths.

Question 74: Microaggressions in counseling are best described as:

Aggressive confrontational techniques used in therapy
Brief, everyday exchanges that send denigrating messages to members of marginalized groups (Correct answer)
Unconscious countertransference toward minority clients
Overt acts of racial discrimination by counselors

Correct answer: Brief, everyday exchanges that send denigrating messages to members of marginalized groups

Microaggressions, as defined by Sue et al., are commonplace verbal, behavioral, or environmental indignities that communicate hostile or negative slights to marginalized groups.

Question 75: A Type I error occurs when a researcher:

Accepts the alternative hypothesis correctly
Rejects a true null hypothesis (Correct answer)
Uses too small a sample size
Fails to reject a false null hypothesis

Correct answer: Rejects a true null hypothesis

A Type I error is a false positive, rejecting a null hypothesis that is actually true, with probability equal to alpha.

Question 76: Disulfiram (Antabuse) deters drinking mainly by which mechanism?

Stimulating GABA-B receptors
Blocking mu-opioid receptors
Inhibiting aldehyde dehydrogenase so acetaldehyde builds up (Correct answer)
Modulating glutamate transmission

Correct answer: Inhibiting aldehyde dehydrogenase so acetaldehyde builds up

Disulfiram blocks aldehyde dehydrogenase, so drinking causes acetaldehyde buildup with flushing, nausea, and palpitations.

Question 77: A counselor offering distance counseling to a client in another state must primarily consider which legal requirement?

No license is needed if sessions are by video only
Counselors must follow the laws and licensure rules of both their own state and the client's state (Correct answer)
Federal law overrides state licensure for telehealth
Counselors only need a license in the state where they sit

Correct answer: Counselors must follow the laws and licensure rules of both their own state and the client's state

ACA Code H.1.b requires distance counselors to follow the laws of both their own location and the client's location, and licensure usually depends on where the client is.

Question 78: Which theorist introduced the concept of 'generativity vs. stagnation' in middle adulthood?

Carl Jung
Erik Erikson (Correct answer)
Daniel Levinson
George Vaillant

Correct answer: Erik Erikson

Erikson's seventh psychosocial stage — generativity vs. stagnation — occurs in middle adulthood and centers on contributing to future generations through work, parenting, or community.

Question 79: Savickas's Career Construction Theory extends Super's work by focusing on:

Six personality-environment types
The narrative meaning clients construct about their career experiences (Correct answer)
Genetic influences on career choice
Social barriers and self-efficacy

Correct answer: The narrative meaning clients construct about their career experiences

Mark Savickas's Career Construction Theory emphasizes the personal narratives and life themes clients use to construct meaning from their career experiences.

Question 80: The Myers-Briggs Type Indicator (MBTI) is based on the personality theory of:

Abraham Maslow
Erik Erikson
Carl Jung (Correct answer)
Gordon Allport

Correct answer: Carl Jung

The MBTI was developed by Isabel Briggs Myers and her mother Katharine Cook Briggs based on Carl Jung's theory of psychological types.

Question 81: A counselor reviews progress and finds the client is not improving after several sessions. What is the most appropriate next step?

Terminate without discussion
Increase the session length without discussion
Revisit and revise the treatment plan or consider referral (Correct answer)
Continue the same plan unchanged

Correct answer: Revisit and revise the treatment plan or consider referral

Treatment plans should be reviewed and revised regularly. A lack of progress should lead the counselor to adjust goals or interventions, consult, or refer if needed.

Question 82: Yalom's curative factors in group therapy include all of the following EXCEPT:

Instillation of hope
Altruism
Universality
Cognitive restructuring (Correct answer)

Correct answer: Cognitive restructuring

Yalom identified 11 therapeutic factors in group therapy; cognitive restructuring is a CBT technique but is not one of Yalom's specific curative factors.

Question 83: Criterion-related validity is demonstrated when:

The test measures the theoretical construct as intended
Scores correlate with a relevant external criterion (Correct answer)
Items adequately represent the full content domain
Items show consistent internal correlations

Correct answer: Scores correlate with a relevant external criterion

Criterion-related validity is evidenced by a significant correlation between test scores and an external criterion, either concurrently or predictively.

Question 84: Ecological assessment in counseling refers to:

Evaluating the client within the context of their environment and systems (Correct answer)
Testing cognitive abilities in natural settings
Conducting environmental impact assessments
Using computer-adaptive testing platforms

Correct answer: Evaluating the client within the context of their environment and systems

Ecological assessment takes a systems perspective, evaluating clients within their environmental contexts — family, school, community, and culture — rather than in isolation.

Question 85: In an open group, which challenge is most likely compared to a closed group?

Members cannot leave until the group ends
Cohesion is harder to keep as membership changes (Correct answer)
Confidentiality does not apply
The group can never go past the initial stage

Correct answer: Cohesion is harder to keep as membership changes

Open groups add and lose members over time, which can disrupt cohesion and continuity.

Question 86: Kohlberg's highest level of moral development is called:

Conventional
Postconventional (Correct answer)
Preconventional
Transcendental

Correct answer: Postconventional

Kohlberg's Postconventional level involves reasoning based on abstract principles of justice and universal ethical values, independent of societal laws.

Question 87: In Bronfenbrenner's ecological model, the relationship between a child's parents and teachers belongs to the:

Microsystem
Exosystem
Mesosystem (Correct answer)
Chronosystem

Correct answer: Mesosystem

The mesosystem is made up of the connections between a child's microsystems, such as home and school.

Question 88: A researcher rejects the null hypothesis when it is actually true. What type of error is this?

Type I error (Correct answer)
Sampling error
Type II error
Measurement error

Correct answer: Type I error

A Type I error is a false positive: rejecting a true null hypothesis. Its probability is the alpha level. A Type II error is failing to reject a false null hypothesis.

Question 89: In Bowenian Family Systems Theory, what term describes the ability to distinguish thoughts from emotions?

Differentiation of self (Correct answer)
Emotional cutoff
Multigenerational transmission
Triangulation

Correct answer: Differentiation of self

Differentiation of self refers to the capacity to maintain a clear sense of identity while remaining emotionally connected to others, a cornerstone of Bowen's theory.

Question 90: In James and Gilliland's six-step crisis model, which step comes first?

Making plans
Examining alternatives
Defining the problem (Correct answer)
Obtaining commitment

Correct answer: Defining the problem

The listening steps are defining the problem, ensuring client safety, and providing support, followed by the acting steps.

Question 91: A counselor randomly assigns 60 clients to either a CBT group or a waitlist control group and compares anxiety scores afterward. What type of design is this?

Ex post facto design
Correlational design
True experimental design (Correct answer)
Quasi-experimental design

Correct answer: True experimental design

Random assignment to treatment and control conditions defines a true experimental design.

Question 92: When should discharge or termination planning ideally begin?

Once the client requests to stop
At the final session
Early in treatment, as part of the initial plan (Correct answer)
Only after insurance benefits run out

Correct answer: Early in treatment, as part of the initial plan

Planning for termination from the start keeps treatment goal-directed and prepares the client for ending.

Question 93: An evaluation conducted during program implementation to provide feedback for improvement is called:

Summative evaluation
Meta-evaluation
Formative evaluation (Correct answer)
Impact evaluation

Correct answer: Formative evaluation

Formative evaluation occurs while a program is ongoing and is used to refine and improve it.

Question 94: For a pregnant client with opioid use disorder, what is the recommended standard of care?

Medication for OUD such as methadone or buprenorphine (Correct answer)
Immediate medically supervised withdrawal
Abrupt discontinuation of all opioids
Naltrexone induction in the first trimester

Correct answer: Medication for OUD such as methadone or buprenorphine

ACOG and SAMHSA recommend methadone or buprenorphine during pregnancy because withdrawal raises relapse and overdose risk.

Question 95: What does current research suggest about single-session Critical Incident Stress Debriefing (CISD) for trauma survivors?

It does not prevent PTSD and may increase distress for some individuals (Correct answer)
It works best when delivered months after the event
It is effective only for children
It reliably prevents PTSD and is mandated after disasters

Correct answer: It does not prevent PTSD and may increase distress for some individuals

Reviews found mandatory psychological debriefing does not prevent PTSD and can be harmful, so PFA is preferred.

Question 96: In Ellis's ABC model, which element is considered the main cause of emotional consequences?

Beliefs about the activating event (Correct answer)
The activating event itself
The dispute of the belief
The behavioral consequence

Correct answer: Beliefs about the activating event

REBT holds that beliefs (B), not activating events (A), largely produce emotional consequences (C).

Question 97: Which psychometric property indicates that a test consistently measures what it measures across repeated administrations?

Validity
Reliability (Correct answer)
Norming
Standardization

Correct answer: Reliability

Reliability refers to the consistency and stability of test scores across time, raters, or forms, and is a prerequisite for test validity.

Question 98: Disruptive mood dysregulation disorder should not be diagnosed for the first time before age 6 or after age:

18 (Correct answer)
16
12
10

Correct answer: 18

DMDD is first diagnosed between ages 6 and 18, and symptoms must begin before age 10.

Question 99: According to Gottfredson's theory of circumscription and compromise, which aspect of the self-concept are people typically LEAST willing to sacrifice when compromising on career choices?

Occupational prestige
Field of interest
Sex-type (gender appropriateness) (Correct answer)
Salary level

Correct answer: Sex-type (gender appropriateness)

Gottfredson proposed that people give up interests first, then prestige, and protect sex-type the most because it develops earliest.

Question 100: Insomnia disorder requires sleep difficulty at least 3 nights per week for at least:

1 month
6 months
3 months (Correct answer)
2 weeks

Correct answer: 3 months

Insomnia disorder requires at least 3 nights per week for at least 3 months, and shorter cases are coded as episodic.

Question 101: Social Cognitive Career Theory (SCCT) was developed by:

John Holland
Donald Super
Frank Parsons
Robert Lent, Steven Brown, and Gail Hackett (Correct answer)

Correct answer: Robert Lent, Steven Brown, and Gail Hackett

SCCT was developed by Lent, Brown, and Hackett (1994), grounded in Bandura's self-efficacy theory, focusing on how beliefs about abilities shape career interests and choices.

Question 102: Which type of group has the primary purpose of providing information and preventing problems?

Therapy group
Support group
Psychoeducational group (Correct answer)
Counseling group

Correct answer: Psychoeducational group

Psychoeducational groups focus on providing structured information, developing skills, and preventing problems before they become significant clinical issues.

Question 103: A client abruptly stopping long-term heavy alcohol use is most at risk for which potentially life-threatening withdrawal complication?

Delirium tremens (Correct answer)
Sedation
Weight gain
Hypersomnia

Correct answer: Delirium tremens

Alcohol withdrawal can progress to delirium tremens, marked by confusion, hallucinations, autonomic instability, and seizures. It requires medical supervision.

Question 104: In the typical sequence of counseling, which step should come first in forming a treatment plan?

Evaluating outcomes
Terminating counseling
Writing the discharge summary
Completing a thorough assessment and diagnosis (Correct answer)

Correct answer: Completing a thorough assessment and diagnosis

Treatment plans are built on information from intake, assessment, and diagnosis. Goals, interventions, and evaluation follow.

Question 105: Attachment theory, developed by John Bowlby, emphasizes which of the following?

The role of peers in socialization
The importance of early caregiver bonds for emotional development (Correct answer)
Genetic determinism in personality
The Oedipal conflict resolution

Correct answer: The importance of early caregiver bonds for emotional development

Bowlby's attachment theory holds that the quality of early bonds with caregivers creates internal working models that shape future relationships and emotional regulation.

Question 106: Eye Movement Desensitization and Reprocessing (EMDR) is primarily used to treat which condition?

Schizophrenia
Obsessive-Compulsive Disorder
Bipolar Disorder
Post-Traumatic Stress Disorder (PTSD) (Correct answer)

Correct answer: Post-Traumatic Stress Disorder (PTSD)

EMDR, developed by Francine Shapiro, is an evidence-based therapy for PTSD that uses bilateral stimulation while clients recall traumatic memories.

Question 107: What is the minimum duration of depressed or irritable mood needed to diagnose persistent depressive disorder in a 14-year-old?

3 months
2 years
6 months
1 year (Correct answer)

Correct answer: 1 year

Children and adolescents need 1 year of symptoms instead of the 2 years required for adults, and irritable mood can count.

Question 108: An infant approaches the caregiver at reunion but then freezes and shows dazed, contradictory behavior in the Strange Situation. This pattern is classified as:

Secure
Avoidant
Anxious-ambivalent
Disorganized (Correct answer)

Correct answer: Disorganized

Main and Solomon described disorganized attachment, often linked to frightening or abusive caregiving.

Question 109: To prove malpractice, a client must establish four elements. Which set is correct?

Intent, harm, negligence, and a written complaint
Duty, disclosure, dual relationship, damages
Duty, dereliction (breach), direct causation, damages (Correct answer)
Licensure, breach, intent, and restitution

Correct answer: Duty, dereliction (breach), direct causation, damages

Malpractice requires a professional duty, a breach of the standard of care, harm directly caused by that breach, and actual damages.

Question 110: A client says, 'I know my drinking is hurting my family, but I'm not sure I'm ready to give it up.' Which stage of change fits best?

Action
Preparation
Contemplation (Correct answer)
Precontemplation

Correct answer: Contemplation

Contemplation is marked by ambivalence: the client sees the problem but has not yet committed to change.

Question 111: Frank Parsons is credited with founding the vocational guidance movement and emphasizing:

Matching individual traits to occupational requirements (Trait-and-Factor theory) (Correct answer)
Developmental stages of career maturity
Self-concept implementation in career choice
Happenstance and unplanned career events

Correct answer: Matching individual traits to occupational requirements (Trait-and-Factor theory)

Frank Parsons, often called the 'father of vocational guidance,' developed Trait-and-Factor theory, matching individual traits (abilities, interests) to job requirements.

Question 112: In career counseling, 'work values' assessments measure:

A client's personality style
What activities a client enjoys
What a client believes is important and rewarding in work (Correct answer)
A client's vocational aptitude

Correct answer: What a client believes is important and rewarding in work

Work values assessments, such as the Minnesota Importance Questionnaire, identify what clients find intrinsically or extrinsically rewarding in a work setting.

Question 113: A biopsychosocial assessment is valuable for case conceptualization because it:

Focuses only on medical history
Captures biological, psychological, and social influences on the problem (Correct answer)
Replaces the need for a diagnosis
Is required only for psychiatric hospitalization

Correct answer: Captures biological, psychological, and social influences on the problem

The biopsychosocial model gives a holistic view of interacting factors behind a client's concerns.

Question 114: In collectivistic cultures, which counseling approach may need to be adapted because it emphasizes individual autonomy and self-disclosure?

Behavioral activation
Traditional person-centered therapy (Correct answer)
Structural family therapy
Narrative therapy

Correct answer: Traditional person-centered therapy

Person-centered therapy's emphasis on individual autonomy, self-disclosure, and emotional expression may conflict with collectivistic cultural values that prioritize group harmony and indirect communication.

Question 115: The O*NET database is a primary resource used by career counselors to:

Schedule career counseling appointments online
Administer personality assessments
File unemployment insurance claims
Access detailed occupational information including tasks, skills, and salary data (Correct answer)

Correct answer: Access detailed occupational information including tasks, skills, and salary data

O*NET is a comprehensive U.S. Department of Labor database providing detailed descriptions of occupations, required skills, education, wages, and job outlook.

Question 116: Which of the following is a protective factor in a case conceptualization?

A supportive extended family network (Correct answer)
Family history of substance use
Chronic insomnia
Recent divorce

Correct answer: A supportive extended family network

Protective factors are strengths and resources that buffer against the problem.

Question 117: In the United States, which demographic group has the highest suicide rate?

Men aged 75 and older (Correct answer)
Adolescent girls aged 12 to 17
Young adult men aged 18 to 24
Women aged 45 to 64

Correct answer: Men aged 75 and older

CDC data consistently show men aged 75 and older have the highest suicide rate of any age and sex group.

Question 118: During the final stage of a counseling group, which leader task is most important?

Bringing up new deep personal issues
Setting ground rules for the first time
Screening new members
Helping members deal with feelings about separation and apply what they learned outside the group (Correct answer)

Correct answer: Helping members deal with feelings about separation and apply what they learned outside the group

At termination, the leader helps members deal with their feelings about ending and plan how to use what they learned in daily life.

Question 119: A student's report shows a stanine of 5. How should the counselor describe this score?

Well below average
Exactly at the 50th percentile with no variation
Average, within the middle band of the distribution (Correct answer)
Above average, top quarter

Correct answer: Average, within the middle band of the distribution

Stanines run from 1 to 9 with a mean of 5, and stanine 5 covers about the middle 20% of scores.

Question 120: In DSM-5-TR, dissociative fugue is coded as:

A separate dissociative disorder
A feature of dissociative identity disorder only
A subtype of depersonalization/derealization disorder
A specifier of dissociative amnesia (Correct answer)

Correct answer: A specifier of dissociative amnesia

Since DSM-5, dissociative fugue has been a specifier of dissociative amnesia rather than a separate diagnosis.

Question 121: A 15-year-old is making career choices based mostly on their interests, then on their abilities and values. In Ginzberg's theory, this teen is in which period?

Fantasy
Realistic
Tentative (Correct answer)
Crystallization

Correct answer: Tentative

Ginzberg's tentative period (about ages 11-17) moves through interest, capacity, value, and transition substages.

Question 122: A client is ambivalent about changing their drinking and says, 'I know it's a problem, but not yet.' The treatment plan should first emphasize:

Motivational interviewing to resolve ambivalence (Correct answer)
Relapse prevention skills
Referral to detox
Immediate abstinence contracts

Correct answer: Motivational interviewing to resolve ambivalence

Clients in contemplation benefit most from motivational strategies that resolve ambivalence before action.

Question 123: The ideal size for a typical counseling group is:

2–3 members
20+ members
12–15 members
5–8 members (Correct answer)

Correct answer: 5–8 members

A group of 5–8 members is generally considered optimal, balancing diverse perspectives with sufficient time for each member to receive individual attention.

Question 124: According to ASGW ethical guidelines, pregroup screening is conducted primarily to:

Ensure member compatibility and protect potentially vulnerable individuals (Correct answer)
Assess members' insurance coverage
Satisfy state licensing board requirements
Increase group revenue by admitting more members

Correct answer: Ensure member compatibility and protect potentially vulnerable individuals

ASGW guidelines recommend pregroup screening to assess member suitability, explain expectations, and protect individuals who might be harmed by a particular group experience.

Question 125: A counselor tells a third-generation Asian American client, "Your English is really good." According to Sue's taxonomy, this is best classified as a:

Microinvalidation (Correct answer)
Macroaggression
Microinsult
Microassault

Correct answer: Microinvalidation

Treating someone as a perpetual foreigner ("alien in own land") negates their experiential reality, which makes it a microinvalidation.

Question 126: Which scale of measurement has equal intervals and a true zero point?

Ratio (Correct answer)
Interval
Ordinal
Nominal

Correct answer: Ratio

Ratio scales, such as number of counseling sessions attended, have equal intervals and an absolute zero.

Question 127: The racial/cultural identity development model (R/CID) proposed by Sue and Sue describes which early stage where a minority individual may devalue their own cultural group?

Integrative Awareness
Introspection
Resistance and Immersion
Conformity (Correct answer)

Correct answer: Conformity

In the Conformity stage, individuals from minority groups may internalize dominant culture values and devalue their own cultural heritage, sometimes preferring the dominant group's characteristics.

Question 128: According to Caplan's crisis theory, a crisis state is typically time-limited and resolves within approximately:

4 to 6 weeks (Correct answer)
1 to 2 years
6 to 12 months
24 to 72 hours

Correct answer: 4 to 6 weeks

Caplan described crises as self-limiting, usually resolving for better or worse within about 4 to 6 weeks.

Question 129: In Marcia's identity statuses, 'identity foreclosure' means:

No commitment and no exploration
Commitment without exploration (Correct answer)
Exploration without commitment
Commitment with exploration

Correct answer: Commitment without exploration

Identity foreclosure occurs when an individual commits to an identity without exploring alternatives, often adopting parents' values without question.

Question 130: Ainsworth's 'secure attachment' style in infants is characterized by:

No visible reaction to caregiver presence
Distress at separation but comfort upon reunion (Correct answer)
Avoidance of the caregiver upon reunion
Extreme distress that is not soothed by the caregiver

Correct answer: Distress at separation but comfort upon reunion

Securely attached infants show moderate distress when caregivers leave and are easily comforted upon return, reflecting a reliable and responsive caregiving history.

Question 131: A counselor says, 'How has Depression been trying to convince you to stay home?' Which approach does this reflect?

Person-centered therapy
Psychoanalytic therapy
Rational emotive behavior therapy
Narrative therapy (Correct answer)

Correct answer: Narrative therapy

Externalizing the problem is a core narrative therapy technique developed by White and Epston.

Question 132: Neurodevelopmental disorders such as ADHD are typically first diagnosed during:

Childhood or adolescence (Correct answer)
Infancy
Middle adulthood
Early adulthood

Correct answer: Childhood or adolescence

According to the DSM-5, neurodevelopmental disorders like ADHD must have symptoms present before age 12 and are typically identified during childhood or adolescence.

Question 133: Schlossberg's transition model looks at a person's ability to cope with a job loss in terms of the '4 S's.' Which set is correct?

Situation, Self, Support, Strategies (Correct answer)
Situation, Stress, Skills, Success
Stress, Skills, Support, Stability
Self, Status, Structure, Strategies

Correct answer: Situation, Self, Support, Strategies

Schlossberg's 4 S's are Situation, Self, Support, and Strategies, which are the resources a person draws on during a transition.

Question 134: The legal duty to warn (Tarasoff ruling) requires counselors to take action when:

A client makes a specific, credible threat against an identifiable third party (Correct answer)
A client is severely depressed
A client discloses past criminal behavior
A client refuses prescribed medication

Correct answer: A client makes a specific, credible threat against an identifiable third party

The Tarasoff v. Regents of the University of California ruling established that therapists have a duty to protect identifiable third parties when clients make specific, credible threats against them.

Question 135: What does ASGW stand for in the context of group work?

Association for Social and Group Work
American Standards for Group Wellness
Association for Specialists in Group Work (Correct answer)
American Society for Group Work

Correct answer: Association for Specialists in Group Work

ASGW stands for Association for Specialists in Group Work, a division of ACA that sets professional standards, best practices, and ethical guidelines for group work.

Question 136: A counselor who lacks competence in a specialized area is obligated to:

Seek supervision only after beginning treatment
Terminate counseling immediately without referral
Attempt to treat the client with available skills
Refer to or consult with a competent professional (Correct answer)

Correct answer: Refer to or consult with a competent professional

The ACA Code of Ethics requires counselors to practice within the boundaries of their competence and to refer, consult, or seek supervision when working outside their expertise.

Question 137: A client afraid of sweating in public is told to try to sweat as much as possible in front of others. Which technique is this?

Systematic desensitization
Paradoxical intention (Correct answer)
Dereflection
Flooding

Correct answer: Paradoxical intention

Frankl's paradoxical intention has clients deliberately wish for the feared outcome, which reduces anticipatory anxiety.

Question 138: The 'Happenstance Learning Theory' suggests that career counselors should help clients:

Only pursue careers matching their RIASEC code
Remain curious and open to unplanned opportunities (Correct answer)
Plan meticulously to avoid unexpected events
Commit to a single career path early

Correct answer: Remain curious and open to unplanned opportunities

Krumboltz's Happenstance Learning Theory encourages clients to engage in exploratory behaviors, remain open to unplanned learning events, and capitalize on chance opportunities.

Question 139: Carol Gilligan criticized Kohlberg's theory mainly for:

Overlooking an ethic of care and relationships (Correct answer)
Leaving out stages for older adults
Placing too much weight on biological maturation
Ignoring the role of the unconscious

Correct answer: Overlooking an ethic of care and relationships

Gilligan argued that Kohlberg's justice-based model, built on male samples, undervalued care-oriented moral reasoning.

Question 140: Which of the following best describes the primary goal of crisis intervention?

Producing insight into childhood conflicts
Resolving the client's underlying personality issues
Developing a long-term treatment plan
Restoring the client to the pre-crisis level of functioning (Correct answer)

Correct answer: Restoring the client to the pre-crisis level of functioning

Crisis intervention is short-term and focuses on stabilization, safety, and a return to precrisis functioning, not on deep personality change.

Question 141: Multicultural career counseling recognizes that career development theories were largely developed on which population?

White, middle-class, Western males (Correct answer)
Women in non-Western cultures
Military veterans transitioning to civilian work
Economically disadvantaged youth

Correct answer: White, middle-class, Western males

Scholars have critiqued traditional career theories for being developed primarily on White, middle-class, Western male samples and not adequately accounting for systemic barriers faced by diverse clients.

Question 142: HIPAA primarily governs which aspect of counseling practice?

The privacy and security of clients' protected health information (Correct answer)
Supervision requirements for licensure
State licensure requirements
Insurance reimbursement rates

Correct answer: The privacy and security of clients' protected health information

HIPAA, the Health Insurance Portability and Accountability Act, establishes federal standards for protecting the privacy and security of individually identifiable health information.

Question 143: In an emergency where a client is an imminent danger to self, a counselor may ethically:

Breach confidentiality to initiate hospitalization or safety measures (Correct answer)
Refer the client to another therapist immediately
Contact the client's employer
Do nothing without explicit client consent

Correct answer: Breach confidentiality to initiate hospitalization or safety measures

Imminent danger to self constitutes a recognized exception to confidentiality, permitting counselors to take necessary steps — including hospitalization — to protect the client's life.

Question 144: A client's recent job loss triggered a depressive episode. In the 4 P's model, the job loss is best classified as a:

Protective factor
Predisposing factor
Perpetuating factor
Precipitating factor (Correct answer)

Correct answer: Precipitating factor

Precipitating factors are the immediate triggers that set off the current problem.

Question 145: Prolonged Exposure therapy, developed by Edna Foa, primarily works by:

Teaching mindfulness to accept trauma symptoms
Reframing family roles after a crisis
Challenging stuck points through written worksheets
Imaginal and in vivo exposure to reduce avoidance and fear (Correct answer)

Correct answer: Imaginal and in vivo exposure to reduce avoidance and fear

PE uses repeated imaginal revisiting and real-life exposure to feared but safe situations to promote emotional processing.

Question 146: When assessing a client experiencing intimate partner violence, which factor on Campbell's Danger Assessment is a particularly strong predictor of intimate partner homicide?

The client has a college degree
The couple has been together more than five years
The partner has previously attempted strangulation (Correct answer)
The partner works night shifts

Correct answer: The partner has previously attempted strangulation

Prior nonfatal strangulation greatly increases the risk of later homicide, along with partner access to firearms.

Question 147: What primarily distinguishes a quasi-experimental design from a true experiment?

Absence of random assignment to groups (Correct answer)
Absence of a dependent variable
Use of qualitative data only
Use of a single participant

Correct answer: Absence of random assignment to groups

Quasi-experiments compare groups, but participants are not randomly assigned, often because intact groups are used.

Question 148: Which legal case established that mental health professionals may have a duty to protect identifiable third parties from a client's threatened violence?

Wyatt v. Stickney
Tarasoff v. Regents of the University of California (Correct answer)
Roe v. Wade
Jaffee v. Redmond

Correct answer: Tarasoff v. Regents of the University of California

Tarasoff (1974, 1976) established the duty to warn and protect identifiable victims of a client's serious threat.

Question 149: The ACA Code of Ethics (2014) addresses multicultural counseling primarily by requiring counselors to:

Complete a minimum number of multicultural training hours each licensure cycle
Actively work to understand and respect diverse cultural backgrounds when providing services (Correct answer)
Specialize in at least one cultural group outside their own
Refuse to serve clients from cultural backgrounds they are unfamiliar with

Correct answer: Actively work to understand and respect diverse cultural backgrounds when providing services

The ACA Code of Ethics requires counselors to actively understand and respect cultural differences and to seek training when working with populations outside their cultural competence.

Question 150: A client discloses a specific plan to harm a named person. Which duty is the counselor most likely to have, based on Tarasoff and its successors?

Duty to keep the information confidential in all cases
Duty to warn and protect the identifiable victim (Correct answer)
Duty to diagnose the client
Duty to terminate counseling immediately

Correct answer: Duty to warn and protect the identifiable victim

Tarasoff and subsequent state laws established a duty to warn or protect identifiable potential victims from serious threats of violence. Specific requirements vary by jurisdiction.

Question 151: The ADDRESSING framework (Hays, 2008) is used in multicultural counseling primarily to:

Diagnose culturally specific mental health conditions
Assess a client's readiness for change
Structure a culturally adapted cognitive-behavioral intervention
Identify multiple cultural influences and potential privilege or marginalization (Correct answer)

Correct answer: Identify multiple cultural influences and potential privilege or marginalization

The ADDRESSING framework helps counselors systematically consider multiple cultural factors (Age, Disability, Religion, Ethnicity, Social status, Sexual orientation, Indigenous heritage, National origin, Gender) that shape a client's identity.

Question 152: Which therapy focuses on accepting uncomfortable thoughts rather than eliminating them?

Behavioral Activation
Psychoanalysis
REBT
Acceptance and Commitment Therapy (ACT) (Correct answer)

Correct answer: Acceptance and Commitment Therapy (ACT)

ACT uses psychological flexibility, mindfulness, and values-based action to help clients accept unwanted inner experiences rather than fight them.

Question 153: During a group session, a member keeps telling long stories about past events while others disengage. Which leader skill best redirects the group?

Reflecting feelings
Summarizing
Self-disclosure
Cutting off (Correct answer)

Correct answer: Cutting off

Cutting off politely interrupts a monopolizing member so others can participate and the group stays focused.

Question 154: The primary role of an Institutional Review Board (IRB) is to:

Protect the rights and welfare of human research participants (Correct answer)
Analyze study data for accuracy
Publish research findings
Approve research funding

Correct answer: Protect the rights and welfare of human research participants

IRBs review research protocols to ensure the protection of human participants, as required by federal regulations.

Question 155: Which evidence-based approach teaches family members positive communication skills to help a treatment-refusing loved one enter treatment?

Al-Anon detachment
Community Reinforcement and Family Training (CRAFT) (Correct answer)
Strategic family therapy
Johnson confrontational intervention

Correct answer: Community Reinforcement and Family Training (CRAFT)

CRAFT trains concerned significant others in non-confrontational strategies and has higher treatment-entry rates than confrontational interventions.

Question 156: The ethical principle of 'autonomy' in counseling refers to:

Avoiding actions that harm the client
Treating all clients fairly
Respecting the client's right to make their own decisions (Correct answer)
Acting in the client's best interest

Correct answer: Respecting the client's right to make their own decisions

Autonomy is the ethical principle that recognizes and respects clients' rights to self-determination and to make informed choices about their own lives.

Question 157: A counselor sets treatment goals with the client instead of for the client mainly in order to:

Avoid documenting the plan
Shorten the intake interview
Increase client motivation and strengthen the working alliance (Correct answer)
Satisfy managed care requirements only

Correct answer: Increase client motivation and strengthen the working alliance

Collaborative goal setting builds ownership and the therapeutic alliance, both of which predict better outcomes.

Question 158: A 52-year-old client says he feels he has contributed nothing to the next generation and his life feels stagnant. Which Eriksonian crisis is most relevant?

Integrity vs. despair
Intimacy vs. isolation
Generativity vs. stagnation (Correct answer)
Identity vs. role confusion

Correct answer: Generativity vs. stagnation

Generativity vs. stagnation is the middle-adulthood crisis about guiding and contributing to future generations.

Question 159: Motivational Interviewing (MI) is based on which key spirit?

Directive instruction and skill-building
Partnership, acceptance, compassion, and evocation (Correct answer)
Confrontation and correction
Psychoeducation and homework

Correct answer: Partnership, acceptance, compassion, and evocation

MI's spirit rests on partnership, acceptance, compassion, and evocation (PACE), prioritizing collaboration and drawing out the client's own motivation.

Question 160: In Roberts' Seven-Stage Crisis Intervention Model, the first stage involves:

Conducting a biopsychosocial and lethality assessment (Correct answer)
Developing an action plan
Exploring feelings and emotions
Follow-up planning

Correct answer: Conducting a biopsychosocial and lethality assessment

Roberts' model begins with assessing lethality and imminent danger alongside a biopsychosocial assessment.

Question 161: Under federal law, which type of record has the strictest confidentiality protections and generally requires specific written consent for nearly any disclosure?

General medical records under HIPAA
School counseling notes under FERPA
Employee assistance program attendance logs
Substance use disorder treatment records from federally assisted programs under 42 CFR Part 2 (Correct answer)

Correct answer: Substance use disorder treatment records from federally assisted programs under 42 CFR Part 2

42 CFR Part 2 protects substance use disorder treatment records from federally assisted programs more strictly than standard HIPAA rules.

Question 162: Which screening tool was designed specifically for substance use risk in adolescents?

MAST
AUDIT-C
CRAFFT (Correct answer)
CAGE

Correct answer: CRAFFT

The CRAFFT is a brief, validated screen for adolescents aged 12 to 21, and its name is an acronym for its items (Car, Relax, Alone, Forget, Friends, Trouble).

Question 163: Kitchener's ethical principle of 'fidelity' refers to which counselor obligation?

Avoiding actions that cause harm
Treating all clients fairly and equally
Respecting the client's right to make their own decisions
Honoring commitments and keeping promises to clients (Correct answer)

Correct answer: Honoring commitments and keeping promises to clients

Fidelity means being faithful to commitments and trustworthy in the therapeutic relationship.

Question 164: Informed consent in counseling must include which of the following elements?

Guarantees of treatment outcomes
The client's diagnosis and prognosis
The counselor's educational background and financial history
The nature of services, fees, risks, benefits, and limits of confidentiality (Correct answer)

Correct answer: The nature of services, fees, risks, benefits, and limits of confidentiality

Ethical informed consent includes explaining the nature and purpose of services, fees, potential risks and benefits, and the limits of confidentiality before counseling begins.

Question 165: A treatment plan should be revised most urgently when:

The insurance company changes its logo
The client shows no progress on objectives after a reasonable period (Correct answer)
The client reschedules one appointment
The counselor wants to try a new technique

Correct answer: The client shows no progress on objectives after a reasonable period

Lack of progress is a key signal to reassess the conceptualization and adjust the plan.

Question 166: Under DSM-5-TR, a client who meets 5 of the 11 substance use disorder criteria is classified as having what severity?

Persistent
Mild
Moderate (Correct answer)
Severe

Correct answer: Moderate

DSM-5-TR classifies 2-3 criteria as mild, 4-5 as moderate, and 6 or more as severe.

Question 167: Which theorist described eight stages of psychosocial development from birth to death?

Sigmund Freud
Lawrence Kohlberg
Erik Erikson (Correct answer)
Jean Piaget

Correct answer: Erik Erikson

Erik Erikson proposed eight psychosocial stages, each presenting a crisis that must be resolved for healthy development, spanning infancy through late adulthood.

Question 168: Which federal regulation specifically protects the confidentiality of records from federally assisted substance use disorder treatment programs?

The Tarasoff ruling
Title IX
FERPA
42 CFR Part 2 (Correct answer)

Correct answer: 42 CFR Part 2

42 CFR Part 2 adds confidentiality protections for SUD treatment records beyond those in HIPAA.

Question 169: A college freshman plans to become a dentist only because her parents expect it and has never considered other options. Marcia would describe her identity status as:

Achievement
Diffusion
Foreclosure (Correct answer)
Moratorium

Correct answer: Foreclosure

Foreclosure is commitment without exploration, often adopting others' values.

Question 170: In Cross's Nigrescence model, which stage involves deep involvement in Black culture along with a rejection of White culture?

Encounter
Immersion-Emersion (Correct answer)
Internalization
Pre-encounter

Correct answer: Immersion-Emersion

Immersion-Emersion is marked by intense focus on Black identity and withdrawal from White culture.

Question 171: Which level of care is most appropriate for a client who needs more structure than weekly therapy but does not require 24-hour supervision?

No treatment
Intensive outpatient program (Correct answer)
Inpatient hospitalization
Self-help reading only

Correct answer: Intensive outpatient program

Intensive outpatient programs offer several hours of treatment multiple days per week while the client lives at home. Inpatient care is reserved for people needing 24-hour supervision or stabilization.

Question 172: The concept of 'fidelity' in counseling ethics means:

Avoiding harm in clinical practice
Doing good for the client
Ensuring fair treatment for all clients
Being honest and keeping promises and commitments to clients (Correct answer)

Correct answer: Being honest and keeping promises and commitments to clients

Fidelity involves honoring commitments, keeping promises, and being truthful with clients, which forms the basis of the therapeutic relationship and trust.

Question 173: In Glasser's WDEP system used in reality therapy, what does the 'E' stand for?

Empathy
Encouragement
Exploration
Evaluation (Correct answer)

Correct answer: Evaluation

E refers to the client's self-evaluation of whether current behavior is getting them what they want.

Question 174: During a suicide risk assessment, which factor is generally considered the strongest predictor of imminent risk?

A specific plan with available means and intent (Correct answer)
Recent job change
Feeling sad in the past month
A family history of depression

Correct answer: A specific plan with available means and intent

A specific plan, access to lethal means, and stated intent signal high acute risk. The other options are risk factors but do not indicate imminence.

Question 175: A 'monopolizer' in a group is best addressed by the leader by:

Privately confronting the member outside the session
Ignoring the behavior to avoid conflict
Redirecting to other members and processing the group dynamic (Correct answer)
Asking the member to leave the group

Correct answer: Redirecting to other members and processing the group dynamic

The leader should gently redirect participation to other members and, when appropriate, process the monopolizing behavior as a group dynamic that affects everyone.

Question 176: Jeffrey Arnett's term for the period from roughly ages 18 to 25, marked by identity exploration and instability, is:

Late adolescence
Emerging adulthood (Correct answer)
Psychosocial moratorium
Early adulthood

Correct answer: Emerging adulthood

Arnett proposed emerging adulthood as a separate stage between adolescence and young adulthood in industrialized societies.

Question 177: In a person-centered approach, case conceptualization focuses mainly on:

Irrational beliefs
Incongruence between the self-concept and experience (Correct answer)
Reinforcement contingencies
Unresolved Oedipal conflicts

Correct answer: Incongruence between the self-concept and experience

Rogers viewed distress as arising from incongruence between self-concept and actual experience.

Question 178: A counselor running a group for middle school students must explain limits of confidentiality. Which statement is most accurate?

Confidentiality rules do not apply to minors
The counselor can guarantee that every member keeps what is said private
Members may share anything as long as they leave out names
The counselor will keep confidentiality but cannot guarantee that other members will (Correct answer)

Correct answer: The counselor will keep confidentiality but cannot guarantee that other members will

Leaders must tell members that they cannot guarantee other members will keep what is said confidential.

Question 179: A person argues that an unjust law should be broken because it violates universal ethical principles of human dignity. This reflects which Kohlberg level?

Conventional
Concrete operational
Postconventional (Correct answer)
Preconventional

Correct answer: Postconventional

Postconventional reasoning relies on self-chosen universal principles that may go beyond laws.

Question 180: A treatment program gives clients vouchers or prize draws for each negative urine drug screen. Which approach is this?

Contingency management (Correct answer)
Aversion therapy
Solution-focused therapy
Twelve-step facilitation

Correct answer: Contingency management

Contingency management uses operant conditioning, giving tangible rewards for verified behaviors such as abstinence.

Question 181: Using interviews, observations, and document review to corroborate findings is an example of:

Member checking
Bracketing
Thick description
Triangulation (Correct answer)

Correct answer: Triangulation

Triangulation strengthens credibility by drawing on multiple data sources, methods, or investigators.

Question 182: Which U.S. Department of Labor resource replaced the Dictionary of Occupational Titles (DOT) as the main source of occupational information?

O*NET (Correct answer)
Guide for Occupational Exploration
Standard Occupational Classification Manual
Occupational Outlook Handbook

Correct answer: O*NET

O*NET (Occupational Information Network) replaced the DOT and gives detailed, regularly updated data on occupational characteristics.

Question 183: A spouse calls in sick for a partner who is hungover and pays off their DUI fines. What does this behavior best show?

Enabling (Correct answer)
Tough love
Harm reduction
Detachment

Correct answer: Enabling

Enabling shields the person from the natural consequences of use and can unintentionally keep the addiction going.

Question 184: Students selected for a study because of extremely low self-esteem scores show higher scores on retest even without intervention. Which threat to internal validity is most likely?

Statistical regression (Correct answer)
Maturation
Diffusion of treatment
Instrumentation

Correct answer: Statistical regression

Extreme scores tend to move toward the mean on retest, a phenomenon called statistical regression.

Question 185: Mandatory reporting laws require counselors to report suspected:

All client criminal activity
Domestic violence in all states
Child abuse and neglect (Correct answer)
Elder substance abuse only

Correct answer: Child abuse and neglect

All U.S. states have mandatory reporting laws requiring mental health professionals to report suspected child abuse or neglect to designated child protective services agencies.

Question 186: Reality Therapy, developed by William Glasser, is based on which theory?

Choice Theory (Correct answer)
Social Learning Theory
Object Relations Theory
Attachment Theory

Correct answer: Choice Theory

Reality Therapy is grounded in Choice Theory, which posits that all behavior is chosen to satisfy one of five basic needs: survival, love/belonging, power, freedom, and fun.

Question 187: Which three core constructs form the basis of Social Cognitive Career Theory (SCCT)?

Self-efficacy, outcome expectations, and personal goals (Correct answer)
Congruence, consistency, and differentiation
Interests, values, and abilities
Concern, control, and curiosity

Correct answer: Self-efficacy, outcome expectations, and personal goals

SCCT (Lent, Brown, and Hackett) builds on Bandura's work and centers on self-efficacy beliefs, outcome expectations, and personal goals.

Question 188: Which personality disorder belongs to Cluster B?

Schizotypal
Histrionic (Correct answer)
Obsessive-compulsive
Avoidant

Correct answer: Histrionic

Cluster B (dramatic, emotional, erratic) includes antisocial, borderline, histrionic, and narcissistic personality disorders.

Question 189: A community agency surveys residents to identify gaps in mental health services before designing a new program. This is a:

Cost-benefit analysis
Outcome evaluation
Fidelity check
Needs assessment (Correct answer)

Correct answer: Needs assessment

A needs assessment identifies the discrepancy between current and desired conditions before a program is developed.

Question 190: In which DSM-5-TR chapter is hoarding disorder classified?

Obsessive-compulsive and related disorders (Correct answer)
Impulse-control disorders
Anxiety disorders
Personality disorders

Correct answer: Obsessive-compulsive and related disorders

Hoarding disorder is grouped with OCD, body dysmorphic disorder, trichotillomania, and excoriation disorder.

Question 191: In resilience research, which factor is most consistently identified as protective for at-risk youth?

Living in a suburban community
Presence of at least one stable, caring adult relationship (Correct answer)
High socioeconomic status
Average or above intelligence

Correct answer: Presence of at least one stable, caring adult relationship

Research consistently shows that having at least one stable, caring relationship with an adult is the most powerful protective factor against adverse childhood experiences.

Question 192: Gilligan's theory of moral development critiqued Kohlberg for:

Including too many cultural perspectives
Ignoring cognitive development
Overemphasizing an ethic of care at the expense of justice
Basing his stages primarily on male subjects (Correct answer)

Correct answer: Basing his stages primarily on male subjects

Carol Gilligan argued that Kohlberg's model was gender-biased because it was based primarily on male samples and undervalued the care-based moral reasoning more common in women.

Question 193: Which two-letter Holland code shows the LOWEST consistency?

AC (Correct answer)
RI
CR
SE

Correct answer: AC

Artistic and Conventional sit opposite each other on Holland's hexagon, so the AC code has the lowest consistency.

Question 194: A 14-year-old refuses to go to school because she is sure everyone will notice a small pimple. Elkind would call this:

Imaginary audience (Correct answer)
Identity diffusion
Hypothetical-deductive reasoning
Personal fable

Correct answer: Imaginary audience

The imaginary audience is the adolescent belief that one is always being watched and judged by others.

Question 195: A counselor using a functional behavioral analysis would primarily examine:

The client's family genogram
Early childhood attachment patterns
Unconscious defense mechanisms
Antecedents, behaviors, and consequences (Correct answer)

Correct answer: Antecedents, behaviors, and consequences

Functional analysis identifies the ABCs that trigger and reinforce a behavior.

Question 196: The National Counselor Examination (NCE) is required for which credential?

LCSW (Licensed Clinical Social Worker)
LPCC (Licensed Professional Clinical Counselor)
LPC (Licensed Professional Counselor, varies by state)
NCC (National Certified Counselor) (Correct answer)

Correct answer: NCC (National Certified Counselor)

The NCE is the primary examination for the NCC credential, awarded by NBCC (National Board for Certified Counselors), and is also accepted for licensure in many states.

Question 197: Under HIPAA, how are 'psychotherapy notes' treated differently from the rest of the clinical record?

They must be destroyed after each session
They get no protection because they are informal
They are kept separate and generally need specific client authorization to disclose, and clients do not have an automatic right to access them (Correct answer)
They can be released to insurers without authorization

Correct answer: They are kept separate and generally need specific client authorization to disclose, and clients do not have an automatic right to access them

HIPAA gives psychotherapy notes kept apart from the medical record extra protection, so most disclosures need separate authorization.

Question 198: A counselor encourages a client to stay curious, persist, be flexible, stay optimistic, and take risks so they can benefit from unplanned events. This approach reflects:

Ginzberg's developmental theory
Super's life-span, life-space theory
Holland's theory of vocational personalities
Krumboltz's planned happenstance theory (Correct answer)

Correct answer: Krumboltz's planned happenstance theory

Mitchell, Levin, and Krumboltz identified curiosity, persistence, flexibility, optimism, and risk taking as skills for turning chance events into opportunities.

Question 199: In Rogers' person-centered therapy, which core condition refers to the counselor being genuine and authentic?

Congruence (Correct answer)
Unconditional positive regard
Psychological contact
Accurate empathic understanding

Correct answer: Congruence

Congruence means the counselor's inner experience matches outward expression.

National Counselor Examination (NCE)

The NCE is a 200-question multiple-choice examination administered by the National Board for Certified Counselors (NBCC) that assesses professional counseling competency across six work-behavior domains required for national certification as a Licensed Professional Counselor.

200

Questions

225 min

Time Limit

70%

To Pass

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