The exam at a glance
| Cases | 11, each with 3 sections |
|---|---|
| Questions | 130 to 150 (9 to 15 per case); 100 scored |
| Time | 225 minutes, about 20 per case |
| Break | 15 minutes after case 5; the exam clock stops |
| Total sitting | 255 minutes (4 hours 15): 5 for the agreement, 10 for the tutorial, 225 of exam, 15 of break |
| Answers | Multiple choice, A to D; no guessing penalty |
| Unscored | 1 case and some questions; you can’t tell which |
Sites that say 3 hours 15 or 10 cases describe the exam before November 2022.
Reading about the format isn't the same as working through it. Try one case built the same way: parts that lock, every answer explained, about 20 minutes.
Try a free caseWhat a case looks like
| Section | You get | Typical questions |
|---|---|---|
| 1. Intake | The client’s story and history | What to assess, the diagnosis, risk |
| 2. A later session | What changed | The plan, how to respond, the next step |
| 3. Another session | New information | Revising the plan, ethics, ending or transfer |
- Sections lock. Change answers within a section; once you move on, it’s closed. Settle flags first.
- Timing matters. A step that’s right at intake can be wrong two sessions later.
- Only the total counts. No pass mark per domain. See the passing score.
See the format in action: 20 sample questions in three cases, every answer explained.
What the scored questions cover
| Domain | Scored share |
|---|---|
| Counseling Skills and Interventions | 30% |
| Intake, Assessment, and Diagnosis | 25% |
| Professional Practice and Ethics | 15% |
| Treatment Planning | 15% |
| Core Counseling Attributes | 15% |
| Areas of Clinical Focus | 0%* |
| Total | 100% |
* Areas of Clinical Focus, the clients' concerns such as the conditions a case is about, is evaluated through the diagnoses and case scenarios across each form rather than through scored questions of its own.
Work behaviors (tasks) NBCC lists per domain
| Domain | Work behaviors listed |
|---|---|
| Counseling Skills and Interventions | 49 |
| Intake, Assessment, and Diagnosis | 21 |
| Professional Practice and Ethics | 24 |
| Treatment Planning | 16 |
| Core Counseling Attributes | 13 |
| Areas of Clinical Focus | 50 |
| Total | 173 |
Areas of Clinical Focus lists the most work behaviors of any domain.
Pacing the exam
Aim for about 20 minutes per case, but check your pace every few cases rather than every case: long cases run over, short ones under. The screen shows time left, so use these checkpoints:
| When you finish | Time left |
|---|---|
| Case 3 | 2:44 |
| Case 5, then the 15-minute break | 2:03 |
| Case 8 | 1:01 |
| Case 11 | 0:00 |
- Take the break. It doesn’t use your 225 minutes.
- Keep a tally. The screen doesn’t show which case you’re on.
- Behind at a checkpoint? Stop rereading and move on. An easy question later is worth the same point as a hard one now.
Most people finished in time, but running short was the most common exam-day problem among those who failed.
Working a case: what people who passed did
- Read for the client’s own words. Answers often hinge on a quoted phrase.
- Read the question first. Note what it names: a theory, a stage, a first step.
- Narrow to two. Drop options that judge, skip assessment or overstep scope. Then: safety, assessment, the client’s goals.
- One minute, then move. Choose, flag, come back before leaving the section.
- Settle flags before moving on. Closed sections stay closed.
What changes on July 1, 2027
From July 1, 2027: 10 cases, a 360 pass mark on a 100–500 scale, and an optional halfway break after which the first half closes. Questions, sections and the 225 minutes stay the same. See the 2027 changes.
What it felt like to people who took it
- Many items leaned on CBT, REBT, solution-focused work and motivational interviewing.
- Most finished in time; the first cases felt longest.
- Opinions split on whether it felt like their practice exams.
How people passed has the full counts.
NCMHCE exam format FAQ
How many questions are on the NCMHCE?
130 to 150 multiple-choice questions across 11 clinical cases, with 9 to 15 questions per case. 100 of them are scored; one full case and some additional questions are unscored.
How long is the NCMHCE?
225 minutes (3 hours 45 minutes) of exam time, about 20 minutes per case. The whole sitting is 255 minutes (4 hours 15): 5 minutes for the nondisclosure agreement, a 10-minute tutorial, 225 minutes of exam and one 15-minute break after the fifth case. Sites that say 3 hours 15 or 10 cases describe the exam before November 2022.
Is the NCMHCE multiple choice?
Yes. Since the current format was introduced in 2022, every question is multiple choice with four choices, asked about a clinical case that unfolds over an intake and two counseling sessions.
Do people run out of time on the NCMHCE?
Most people who wrote about timing finished, but running short was the most common exam-day problem among those who failed. About 20 minutes per case, with checkpoints at cases 3, 5 and 8, keeps you on pace: roughly 2:44, 2:03 and 1:01 left on the clock.
Sources
- NBCC, NCMHCE content outline: cases, questions, scored items, domains, work behaviors. Accessed August 12, 2026.
- NBCC, Candidate Handbook for State Licensure, NCMHCE (revised Nov. 20, 2025): case sections, navigation, answer choices, session timing and break, scoring, unscored content. Accessed September 23, 2026.
- NBCC, NCMHCE specification effective July 1, 2027. Accessed August 12, 2026.
The free practice case is one full NCMHCE-style case: 14 questions, about 20 minutes, no account needed.
Try the free case