NCE-ABE National Counselor Examination Questions and Answers

In the Counseling and Helping Relationships core area, systemic and family counseling approaches emphasize that:

A family is a system, and problems (such as parental conflict and stepfamily tension) are best understood by observing the entire system interacting.

Early sessions often focus on joining with the whole family, clarifying roles, boundaries, and interaction patterns, especially in blended families where alliances and loyalties can be complex.

Option B, seeing the family as a whole in the first session, allows the counselor to:

Directly observe parent–child and stepparent–stepchild interactions,

Hear each member’s perspective on the arguing and its impact,

Begin to restructure communication and set shared goals collaboratively.

The other options fragment the system:

A (see each child separately) misses the systemic interaction at the heart of the complaint.

C (see parents together) may be useful later but does not initially address how the conflict is affecting the children or the overall family dynamics.

D (each parent with their stepchildren) reinforces existing divisions and alliances rather than treating the family as a single integrated system.

Therefore, B is the most appropriate first-session technique for this blended family issue.

In the Assessment and Testing core area, counselors are required to understand different types of observational and documentation methods used to gather data about client behavior:

An anecdotal report (or anecdotal record) is a narrative, descriptive account of a specific incident or event, written in the observer’s own words. It is inherently subjective and focuses on describing what the client did or said in a particular context. This matches the stem exactly, so Option D is correct.

A rating scale (Option A) involves assigning numerical or descriptive ratings (e.g., “never,” “sometimes,” “often”) to specific behaviors or traits; it is not a narrative description.

A checklist (Option B) is a list of behaviors or characteristics where the observer simply marks whether each behavior was observed; it is not a written narrative.

A cumulative folder (Option C) is a collection of records and documents (e.g., grades, test scores, reports) that summarize a student’s or client’s history over time; it is not a single narrative observation.

Thus, the term that best fits a subjective, narrative description of behavior in a specific situation is anecdotal report (D).

In the Assessment and Testing core area, CACREP requires that counselors understand:

The use of diagnostic classification systems (such as DSM),

The difference between identity or behavior and a mental disorder, and

The central role of distress or impairment in making a diagnosis.

For gender dysphoria, diagnostic criteria emphasize that:

A person may experience incongruence between their experienced/expressed gender and assigned sex,

However, this incongruence alone is not sufficient for a mental health diagnosis,

A diagnosis is appropriate only when the experience is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Evaluating the options:

A. Considering surgical reassignment – Not required for diagnosis. Many individuals with gender dysphoria may never seek surgery.

B. Strong dislike for their anatomy – This can be one feature, but by itself does not justify a diagnosis without associated distress or impairment.

C. Desire for secondary sexual characteristics of another gender – Again, this can be part of the experience but is not sufficient alone to meet diagnostic criteria.

D. There was clinically significant distress. – This is the essential condition across DSM diagnoses: the symptoms must cause clinically significant distress or impairment. Without that, a formal diagnosis of gender dysphoria should not be made.

Therefore, the counselor would only diagnose gender dysphoria if D (there was clinically significant distress) is present.

In Counseling and Helping Relationships, especially in systemic and family counseling, Minuchin’s structural family therapy focuses on:

Family structure (patterns of interaction),

Subsystems,

Boundaries,

Rules and norms that govern behavior.

The “standards that govern behavior” in a family—what is acceptable, expected, or prohibited—are best described as family norms (Option B). These norms shape how members interact, how power is distributed, and how roles are carried out.

Family hierarchy (D) is one important aspect of structure (who has authority over whom), but the broader phrase “standards that govern behavior” aligns more directly with norms and rules across the whole family system.

Genetics (A) and socioeconomic status (C) may influence the family, but they are not Minuchin’s primary explanatory construct for behavioral standards.

Thus, B. Family norms is the best answer.

In the Group Counseling and Group Work core area, CACREP expects counselors to understand different group leadership styles, including democratic, authoritarian, and laissez-faire.

A laissez-faire leader is characterized by minimal direction, low structure, and very little intervention, allowing group members to largely manage their own processes and decisions.

In this scenario, such a leader would not step in to decide the goal (A or C) or actively facilitate group problem-solving (B). Instead, they would allow the members to continue interacting until they naturally reach some resolution, which aligns with D.

Thus, D. Let the two group members continue until some form of resolution had been achieved best reflects a laissez-faire leadership style.

Within the Human Growth and Development core area, the NCE expects knowledge of Piaget’s stages of cognitive development and how children think at different ages.

The preoperational stage (approximately ages 2–7) is marked by:

Egocentric thinking

Magical thinking and fantasy

Difficulty distinguishing appearance from reality

Judging situations based on how things look, not on logical principles

In this question, the 4-year-old believes the 10-year-old has literally disappeared because of a costume. This reflects appearance–reality confusion and prelogical thinking, which are classic features of the preoperational stage.

Sensorimotor (birth–2): focus on sensory experience and object permanence, not costumes/identity.

Concrete operational (7–11): children at this stage can usually understand that a costume does not change who someone is.

Formal operational (11+): abstract reasoning; far beyond this situation.

Therefore, the behavior described matches Piaget’s preoperational stage, making D correct.

This question falls under Professional Counseling Orientation and Ethical Practice, especially ethical standards, professional responsibility, and client rights.

Option A – Using techniques without prior trainingEthical standards require counselors to practice within the boundaries of their competence, which is based on education, training, supervised experience, and appropriate professional experience. Using counseling techniques for which the counselor has no prior training or competence violates these standards and may place clients at risk. This breaches ethical practice.

Option B – Imposing personal valuesCounselors are expected to avoid imposing their own values, attitudes, beliefs, or behaviors on clients, especially when such imposition may interfere with the counseling process or clients’ autonomy. Ethically, counselors must respect the dignity and autonomy of clients and support their ability to make their own decisions. Imposing the counselor’s personal values is clearly unethical.

Option C – Charging higher fees than others in the areaEthical codes state that counselors must establish fees that are consistent with accepted professional practices, explain fees and billing to clients in advance, and avoid exploitation of clients. However, it is not an ethical requirement that a counselor’s fees match or be similar to other providers’ fees in the area.A counselor may charge higher fees if:

The fees are clearly disclosed to the client beforehand,

The client agrees voluntarily, and

The fee structure is not exploitative or fraudulent.Therefore, simply charging higher fees than others does not, by itself, constitute an ethical violation, making C the correct answer.

Option D – Disclosing notes and records without permissionEthical standards emphasize confidentiality as a core duty. Counselors must not disclose client information, counseling notes, or records without the client’s informed consent, except under specific legal or ethical exceptions (e.g., risk of harm, court order, etc.). Disclosing records without permission generally breaches confidentiality and ethical practice.

Because A, B, and D all represent clear ethical violations, while C describes something that is not inherently unethical when done transparently and non-exploitatively, the only option that does not breach ethical counseling practice standards is C.

The Social and Cultural Diversity core area emphasizes that counselors must develop culturally responsive interventions and treatment plans that consider clients’ cultural identities, including religion and spirituality. CACREP-aligned training highlights:

The importance of integrating clients’ cultural values, beliefs, and practices into treatment,

Respecting clients’ spiritual and religious traditions as meaningful components of identity, and

Using culturally congruent resources and supports in counseling goals and interventions.

Looking at the options:

A. Continuous monitoring to maintain rapport – Good general counseling practice, but not specifically an example of addressing diversity in treatment objectives.

B. Assessing individual and family dynamics – Important for case conceptualization, but still not explicitly diversity-focused unless clearly tied to culture.

D. Measuring the client's beliefs of societal systems – This may be part of multicultural assessment, but it is more evaluative than clearly a treatment objective that incorporates diverse resources.

C. Including spiritual and religious resources – Directly exemplifies integrating cultural, spiritual, and religious dimensions into treatment objectives, which is exactly what multicultural counseling competency requires.

Therefore, C (including spiritual and religious resources) is the best example of explicitly addressing diversity in treatment objectives.

The Group Counseling and Group Work core area requires counselors to know the advantages and limitations of using groups in various settings, including career counseling.

One commonly noted limitation is that:

Group members often have a wide range of individual needs, interests, and career concerns.

A group format can make it challenging for the leader to tailor content, activities, and feedback to each person’s unique interests and decision-making stage.

This is exactly what option D describes: the leader may struggle to address the full variety of individual interests in a group setting.

Why the others are not best:

A: It is possible (and common) to assess members’ occupational functioning through intakes, assessments, and individual check-ins, even in group programs.

B: Psychological functioning can be assessed in a group setting; group counselors are trained to observe behavior, collect histories, and use assessment tools.

C: All formats (individual, group, family) have limitations; stating there are none is inconsistent with CACREP’s emphasis on critical evaluation of methods.

Thus, a major limitation in career groups is that the leader can find it difficult to meet the wide range of individual interests, making D the correct answer.

In the Group Counseling and Group Work core area, counselors are trained to use systematic observation to understand group dynamics, members’ behaviors, and group process. Effective observation is intentional, not random. That means the group leader must know what specific behaviors, interactions, or processes they are watching for (e.g., participation patterns, conflict, cohesion, leadership, resistance).

CACREP-based training emphasizes:

Using planned, purposeful observation tied to the group’s goals and stage of development.

Monitoring both verbal and nonverbal behaviors to inform interventions.

While informing members about general observation and taking notes can be good practice, the essential professional skill is having a clear, defined focus for what is being observed, which makes D the best answer.

In the Professional Counseling Orientation and Ethical Practice core area, CACREP highlights counselors’ roles in prevention, psychoeducation, and developmental interventions, including creating and using media and materials that promote mental health, safety, and wellness.

Developmental/preventive media refers to educational materials or presentations (e.g., videos, brochures, classroom presentations, campaigns) designed to promote healthy development and prevent problems before they occur.

In option B, the counselor is facilitating the creation of a video about sexual violence to be shown in school classes. This is clearly a preventive educational tool (media) targeting a large audience to increase awareness, promote safety, and reduce risk—exactly what developmental/preventive media are used for.

Option A (compiling a referral list) is about resource referral, not the creation of media.

Option C (compiling a service report) is program evaluation/administrative documentation, not preventive media.

Option D (creating a needs assessment survey) is used to assess needs, not to directly deliver developmental/preventive content.

Therefore, the best example of a counselor preparing developmental/preventive media is B. Having students in a drama club create a video about sexual violence to show in school classes.

O D. creating a needs assessment survey to be distributed to potential clients.

In the Social and Cultural Diversity core area, counselors are expected to demonstrate multicultural competence, including the ability to broach topics such as race, ethnicity, culture, oppression, identity, and power dynamics.

Broaching is the counselor’s intentional effort to:

Acknowledge and invite discussion of cultural and sociopolitical factors affecting the client,

Normalize and validate the significance of the client’s cultural identities, and

Address how these factors may shape the counseling relationship and presenting concerns.

Best practice is for broaching to occur early and repeatedly:

It should be introduced in the first session to set a foundation that cultural and identity-related issues are welcome topics.

It should continue throughout the counseling process, as relevance may change or deepen over time.

Limiting broaching to referral considerations (A) or only when a client formally requests it (B) contradicts multicultural counseling competencies, which emphasize counselor responsibility.

Doing it only by the second session and at termination (C) makes it infrequent and procedural, rather than an ongoing part of the relationship.

Thus, broaching is implemented in the first session and throughout counseling, making D the correct answer.

In the Assessment and Testing core area, CACREP expects counselors to distinguish between different categories of instruments, including interest inventories, personality tests, aptitude tests, and self-concept measures.

Interest inventories are designed to assess a person’s likes and dislikes regarding activities, subjects, and occupations. They are widely used in career counseling to help people explore suitable fields based on what they enjoy.

They directly ask about preferences—which is exactly what the question describes.

Why the others are not best:

Likert-type scale (B): This is a response format (e.g., strongly agree to strongly disagree), not a type of test by itself. It can be used in many kinds of instruments (attitudes, beliefs, etc.).

Self-concept inventory (C): Focuses on how people see themselves (self-image, self-worth), not primarily on their likes and dislikes about activities or careers.

Projective technique (D): Uses ambiguous stimuli (inkblots, drawings, etc.) to explore personality dynamics, not straightforward preference ratings.

Therefore, an instrument that indicates likes and dislikes is A. An interest inventory.

Within the Group Counseling and Group Work core area, counselor training emphasizes that the group leader has primary responsibility for establishing and facilitating the group process, particularly in the early stages. In existentially oriented groups, the leader:

Actively models authentic, present-centered interaction.

Invites and structures here-and-now dialogue between members.

Encourages members to move from speaking to the leader to speaking to one another.

Although an eventual goal is for members to assume more ownership of the interaction, the initial responsibility for fostering intermember interactions rests with the leader, who intentionally shapes a climate that supports genuine encounter, openness, and exploration of meaning.

Option A (group members alone) minimizes the leader’s intentional facilitating role.

Option C (group members and leader) is partially true in practice, but exam content and theory place primary responsibility on the leader to initiate and sustain interaction patterns.

Option D (leader and strongest group members) is inconsistent with group counseling principles, which avoid privileging “strongest” members and instead promote shared participation.

Therefore, based on group leadership roles taught under the CACREP core area, the best answer is B. The group leader.

Within the Counseling and Helping Relationships core area, CACREP highlights the importance of empathy and the counselor’s ability to be fully present with the client. Empathic attunement refers to:

Deeply tuning in to the client’s emotional experience,

Staying present with the client without judging, fixing, or overanalyzing,

Conveying understanding and acceptance of the client’s internal world.

Active listening (option B) involves attending behaviors and reflective responses, but empathic attunement specifically emphasizes nonjudgmental presence and emotional resonance with the client’s experience. Interpretation (option A) involves analyzing or offering meanings, which is the opposite of simply sitting with the experience. Integration (option C) refers more broadly to combining insights or aspects of the self, not this particular stance.

Within the Counseling and Helping Relationships core area, counselors are expected to understand and apply a range of evidence-based counseling strategies and interventions, including behavioral and cognitive-behavioral techniques for specific problems such as insomnia.

Paradoxical intention is a technique in which the counselor instructs the client to intentionally engage in, or exaggerate, the very symptom they fear or are trying to avoid (in this case, trying to stay awake instead of trying to fall asleep). This counters performance anxiety and reduces the pressure around the symptom.

Not A (Sleep education): Sleep education focuses on teaching about sleep cycles, sleep hygiene, and lifestyle factors, not instructing clients to do the opposite of their goal.

Not B (Mirroring): Mirroring is reflecting the client’s emotional or verbal content, not giving paradoxical directives.

Not D (Stimulus control): Stimulus control involves modifying environmental and behavioral cues that signal sleep (e.g., using the bed only for sleep), not asking the client to try to stay awake.

Therefore, the intervention described is best understood as paradoxical intention (C).

In the Counseling and Helping Relationships core area, CACREP identifies basic counseling skills such as paraphrasing, reflecting feeling, summarizing, and using empathy.

Summarization pulls together several client statements over time, capturing multiple pieces of content and associated feelings, and then checking for accuracy.

In the statement given, the counselor:

Integrates several experiences (setting boundaries, explaining maternity leave, fielding questions).

Reflects the emotional tone (tired of colleagues’ behaviors, not feeling they’re meeting her halfway).

Ends with a checking-for-accuracy question (“Am I understanding that correctly?”).

This is characteristic of summarization, not just a brief paraphrase of one point.

Additive empathy would involve going beyond what has been stated and offering a deeper interpretation not yet voiced by the client. Reflection of meaning focuses more on deeper values and life meaning. Paraphrasing is shorter and usually focuses on just one main idea.

Because the counselor is organizing and restating multiple themes and feelings in a concise way, the best skill label in line with NCE content is C. Summarization.

Under Professional Counseling Orientation and Ethical Practice, CACREP-aligned ethics stress that:

Counselors have a clear duty to protect confidentiality,

But in group counseling, the leader cannot ethically guarantee that other members will maintain confidentiality.

The counselor must explain the limits of confidentiality and encourage members to honor group privacy.

Therefore, the group leader’s ethical obligation is to strongly encourage members not to share group discussions outside the group and to educate them about the importance and rationale for confidentiality. This is captured by Option B.

Option A is unethical because no counselor can guarantee that other members will keep information confidential.

Option C incorrectly suggests members should limit sharing only to non-counseling details, which is not how confidentiality is framed; the focus is on not sharing other members’ counseling-related disclosures.

Option D weakens the standard by suggesting that some sharing is acceptable if “discreet,” which conflicts with the usual ethical guidance to avoid sharing group members’ personal information at all.

Thus, B best reflects the ethical obligation of a group leader regarding confidentiality.

Within the Career Development core area, counselors are trained to view work, career, and leisure as integrated components of overall life satisfaction and well-being. A foundational assumption is that:

Individuals can meet psychological needs (e.g., achievement, affiliation, autonomy, creativity, meaning) through both work roles and leisure activities.

Satisfaction in life may arise from a combination of paid employment, unpaid roles, and leisure pursuits, depending on the client’s values and circumstances.

Thus:

Option C reflects the principle that personal need satisfaction and fulfillment can come from either or both work and leisure, which guides holistic counseling around lifestyle, not just employment.

Options A and D overemphasize a rigid “work-first” ethic and are more value-laden than is appropriate for ethical, client-centered counseling.

Option B assumes that leisure is “preferable” for most adults, which is not supported as a universal counseling assumption and may conflict with many clients’ values around meaningful work.

Therefore, the assumption most aligned with CACREP-based career counseling concepts is C. Personal need satisfaction may be derived from either work or leisure activities.

Within the Counseling and Helping Relationships core area, CACREP emphasizes knowledge of psychoanalytic concepts such as resistance, transference, catharsis, and regression.

In classical psychoanalytic theory, resistance refers to any behavior that impedes the counseling process or avoids threatening, unconscious material. This can include joking, changing the subject, talking about trivial or nonpersonal matters, being late, or intellectualizing instead of addressing feelings.

In this vignette, the adolescent repeatedly tells inappropriate jokes and shifts to unrelated, nonpersonal topics, which function to avoid deeper, emotionally charged material—a textbook example of resistance.

Why the others are not best:

Transference (A): This is when clients unconsciously transfer feelings from earlier significant relationships onto the counselor. That’s about who the feelings are directed toward, not joking and avoiding content.

Catharsis (C): This is an emotional release that comes from expressing previously repressed feelings, usually leading to relief, not avoidance.

Regression (D): This is a return to earlier developmental behaviors in response to stress (e.g., acting childlike), not primarily joking and talking about unrelated topics to avoid personal material.

Thus, the behavior is best understood as B. Resistance.

In the Career Development core area, counselors must understand major theories of career choice, including Holland’s RIASEC model. Holland proposed six personality–environment types: Realistic, Investigative, Artistic, Social, Enterprising, and Conventional.

Investigative types prefer working with ideas, symbols, and abstract concepts, and enjoy activities that involve thinking, analyzing, and problem-solving (often in scientific, mathematical, or theoretical areas). This matches the description in the question.

Social types (A) prefer working with people, helping, teaching, or serving.

Realistic types (B) prefer working with things, tools, machines, or hands-on activities.

Enterprising types (C) prefer persuading, leading, or selling, often in business or leadership settings.

Because the stem emphasizes a preference for ideas, words, and symbols rather than people, things, or persuasion, the classification that best fits Holland’s model is Investigative (Option D).

Within the Social and Cultural Diversity core area, counselors are expected to demonstrate multicultural competence, which includes recognizing how culture, race, ethnicity, and worldview affect clients’ experiences and concerns, and actively exploring these with clients. Ethical and culturally responsive practice involves:

Openly inviting discussion of cultural beliefs, values, and experiences that may influence the client’s presenting concerns.

Avoiding assumptions or minimizing culture as “secondary” to treatment.

Option D reflects this standard: the counselor asks the client directly about any cultural issues or beliefs that may be impacting them, honoring client expertise about their own cultural context and integrating it into case conceptualization and treatment planning.

A places the responsibility fully on the client and can lead to important cultural issues being overlooked.

B contradicts multicultural counseling principles by treating culture as unimportant.

C suggests separating concerns from culture, which ignores the fact that many problems are embedded in cultural, racial, and systemic contexts.

Therefore, D is the strategy that aligns with CACREP’s multicultural and social justice competencies.

In the Counseling and Helping Relationships core area, CACREP includes behavioral and learning theories such as operant conditioning. A foundational principle is that:

Behaviors that are reinforced are more likely to be maintained, and

Behaviors that are no longer reinforced tend to weaken and eventually extinguish.

Option C directly states this assumption: behavior that is not reinforced gradually extinguishes. That is the core explanation for why, in behavior therapy, counselors manipulate reinforcement contingencies to reduce maladaptive behaviors.

A is incorrect because behaviors are not always reinforced on a strict one-to-one (continuous) schedule; intermittent reinforcement can also maintain behavior.

B (shaping) is used to build new complex behaviors, but it is not required for maintaining an already-learned behavior.

D refers to modeling (observational learning), which is associated with social learning theory, not the central assumption about maintenance in basic operant conditioning.

Thus, C is the correct assumption regarding behavior maintenance.

In the Counseling and Helping Relationships core area, CACREP includes knowledge of major counseling theories, including Reality Therapy/Choice Theory. Reality therapy emphasizes:

Personal responsibility for choices and behaviors

Focus on current behavior rather than the past

Collaborative evaluation of whether the client’s behavior is helping them meet their needs

The counselor’s role is not to act as an authority who fixes the client, but as a collaborative partner who:

Builds a warm, involved relationship

Helps the client evaluate their own behavior

Encourages the client to accept responsibility and make more effective choices

Therefore:

Option A (consultant solving problems) is too expert-driven and takes responsibility away from the client.

Option B (effective listener) is necessary but does not capture the responsibility-focused, collaborative nature of reality therapy.

Option C (parental surrogate) conflicts with the reality therapy emphasis on adult responsibility, not dependency.

The best description of the reality therapy counselor’s role is D. A partner who helps the client accept behavioral responsibility.

The Human Growth and Development core area covers developmental differences, including work with children who have intellectual disabilities. Children with mild intellectual impairment typically:

Learn best through concrete, hands-on, and highly structured experiences,

Benefit from clear, specific, and immediately relevant examples, especially in social and interpersonal domains.

Option D (“facilitate active and concrete examples of social interaction”) matches these principles. It uses active practice and concrete modeling to teach social skills, which is consistent with developmentally appropriate interventions for mild intellectual impairment.

A (psychoeducation about recognizing others’ emotions) may be useful but is often too abstract if not paired with concrete, experiential methods.

B focuses on academic support rather than counseling techniques or social-emotional intervention.

C (free play) provides unstructured interaction and may not be sufficient for skill building without guided, concrete instruction.

Therefore, D represents the best technique in line with developmental theory and appropriate intervention strategies for children with mild intellectual impairment.

In the Human Growth and Development core area, CACREP includes understanding theories of human needs, such as Maslow’s hierarchy. According to this framework:

When individuals are under significant financial stress, their basic needs (e.g., housing, food, safety, security) are threatened.

Under such conditions, people are more likely to be preoccupied with survival-level concerns (physiological and safety needs) than with higher-order needs such as development, self-exploration, or complex interpersonal growth.

Options A, B, and C refer to important but higher-level needs relative to basic survival and security. In the presence of acute financial stress, clients understandably prioritize D. Survival needs.

Within Human Growth and Development, counselors are trained to understand how individuals adapt and sometimes grow in response to trauma. Post-traumatic growth is conceptualized not merely as “positive thinking,” but as a process and outcome in which people:

Engage in adaptive coping after trauma,

Do meaning making about what happened,

Experience personal growth (e.g., deeper relationships, new life priorities, greater appreciation of life).

Option B captures this standard definition: it emphasizes both process (coping and meaning making) and outcome (personal growth) following traumatic experiences.

Options A, C, and D are incomplete or overly simplistic—focusing on theory labels or “positivity” rather than the well-established process/outcome framework used in counseling literature and CACREP-aligned training.

When planning treatment for substance use disorders, counselors are expected to prioritize immediate safety and stabilization, followed by the development of skills and environmental changes that support abstinence and recovery. Early treatment typically focuses on:

Physical concerns (A): addressing withdrawal, medical risks, and overall health stability is often the first priority.

Managing stress without substances (B): clients need early coping strategies to handle cravings and stressors without returning to use.

Dysfunctional lifestyle (C): examining and beginning to modify high-risk routines, relationships, and environments that maintain substance use is an early and ongoing focus.

Personality traits (D), while potentially relevant, are typically not an initial focus. Deep exploration of personality structure, enduring traits, or complex characterological issues usually comes later, after stabilization, reduction of use, and establishment of basic coping skills. Addressing these too early can be overwhelming and may distract from urgent recovery tasks.

Therefore, the factor not initially addressed is personality traits, making D the correct answer.

Top of Form

Extended thinking

Bottom of Form

Effective treatment planning is described as a dynamic, ongoing process. Counselors are expected to regularly review treatment goals and progress and revise the plan as needed to reflect the client’s current status.

When a client meets treatment goals earlier than expected, the most appropriate step is to revisit the treatment plan, confirm which goals have been successfully achieved, and then:

Decide whether to add new goals,

Shift focus to maintenance or relapse prevention, or

Begin planning for termination if appropriate.

Option C captures this responsibility to review and revise the treatment plan based on actual client progress.

A (changing medication) is a medical decision and may or may not be relevant; it is not the primary treatment-planning response.

B (referral to group) could be appropriate in some cases, but it should follow a thoughtful treatment-plan review.

D (understanding attitude toward treatment) may be clinically useful, but again it is not the primary, required next step in structured treatment planning.

This directly reflects the Treatment Planning work behavior: monitoring progress and modifying plans to ensure services remain appropriate and goal-directed.

Counselors using assessments must understand basic statistics, including correlation, to interpret test data appropriately. A correlation coefficient (r) ranges from −1.00 to +1.00 and reflects the strength and direction of a linear relationship between two variables.

A correlation of 0 (option A) indicates no linear relationship between the variables—knowing one gives no information about predicting the other in a straight-line fashion.

−1.00 (B) indicates a perfect negative linear relationship: as one variable increases, the other decreases in a perfectly predictable way.

+1.00 (C) indicates a perfect positive linear relationship: as one variable increases, the other also increases in a perfectly predictable way.

Unable to determine (D) is incorrect because the coefficient itself does provide this information.

Therefore, 0 represents a complete lack of linear relationship, making A the correct answer.

Fetal alcohol syndrome (FAS) results from prenatal exposure to alcohol and is characterized by a pattern of:

Central nervous system (CNS) abnormalities

Growth deficiencies

Characteristic facial features

Cognitive, behavioral, and learning difficulties

These effects are considered permanent and irreversible, making Option A correct. While supportive services and interventions can improve functioning and quality of life, the underlying damage does not “heal” or disappear over time [as consistently noted in medical and developmental literature, e.g., CDC and pediatric guidelines].

Why the other options are incorrect:

B. “The effects … are mental rather than physical.”FAS includes both physical and neurodevelopmental effects—growth deficits, facial anomalies, and CNS involvement—not just “mental” effects.

C. “FAS can develop through breastfeeding.”FAS is specifically caused by alcohol exposure in utero; breastfeeding does not cause FAS, although alcohol can affect the infant in other ways.

D. “The children with FAS tend to have average IQs.”Many individuals with FAS have below-average IQ, learning disabilities, and executive functioning deficits. Average IQ is not characteristic of the syndrome as a whole.

Within the NBCC Counselor Work Behavior Areas, counselors are expected to understand key features of developmental and neurobehavioral conditions such as FAS to inform assessment, referral, and appropriate support planning.

Ethical practice requires counselors to avoid multiple relationships when they could impair professional judgment, increase the risk of harm, or exploit the client. Serving simultaneously as both instructor and personal counselor to the same individual creates:

A power differential (grading authority and evaluative role)

Potential for role confusion

Risk that the student may feel pressured or may not be fully free in the counseling relationship

Therefore, the counselor should not enter into a counseling relationship with a current student. The ethically appropriate action is to provide a referral to another qualified mental health professional, as in Option B.

A (asking the student to wait until the course is over) still allows for a future dual relationship and does not completely remove the risk tied to the existing power dynamic.

C (scheduling counseling) directly creates a problematic multiple relationship.

D (redirecting to another faculty member) could create another dual relationship (faculty–student and counselor–client) and is not the cleanest or safest option.

Thus, the counselor should refer the student to another appropriate professional, making B the correct answer.

In accountability and program evaluation, counselors are expected to use data that reflects actual client change to demonstrate effectiveness. Within professional practice, the most powerful and persuasive evidence is outcome data, because it shows:

What changed for clients (e.g., improved career decision-making, job placement, satisfaction with career choice).

The degree to which program goals and client objectives were met.

The impact of services on client functioning and development.

By comparison:

Input data focuses on what resources went into the program (e.g., staff, time, materials).

Context data describes the environment or client population characteristics.

Process data shows what was done (activities, number of sessions), but not whether it worked.

NBCC-aligned counselor work behaviors emphasize using results-focused (outcome) data for accountability to stakeholders and for improving services, which is why outcome data has the greatest impact.

The scenario highlights that:

The client changed their thought process during anxious episodes.

Their reactions were less intense than before.

This indicates the client is applying a coping or cognitive skill learned in counseling—for example, cognitive restructuring, grounding, or other anxiety-management techniques. That is using an acquired skill (B).

A. Collaborative goal-setting is important early in treatment but does not itself explain why symptom intensity decreased.

C. Counselor’s emotional support can be helpful, but the change described is specifically tied to the client’s own cognitive work, not simply emotional support.

D. Time heals all wounds ignores the active, skill-based nature of counseling progress.

NBCC Counselor Work Behavior Areas emphasize helping clients develop, practice, and generalize skills so that they can independently manage symptoms—exactly what is described here.

Within diagnostic work, counselors must distinguish between eating disorders by identifying core diagnostic features. Anorexia nervosa is characterized by restriction of energy intake leading to significantly low body weight, a disturbance in the way one’s body weight or shape is experienced, and, critically, an intense fear of gaining weight or becoming fat, even when underweight. That intense fear is central to both the client’s experience and the clinical diagnosis, making Option B correct.

Option A (repeatedly regurgitating food for at least one month) aligns more with rumination disorder, not anorexia nervosa.

Option C is incorrect: anorexia is more frequently associated with higher-income, industrialized societies, not predominantly low-income countries.

Option D (binge eating) is more characteristic of bulimia nervosa or binge eating disorder; while some people with anorexia (binge-eating/purging type) may binge, it is not the defining feature.

Correctly identifying hallmark symptoms like fear of weight gain reflects the NBCC Intake, Assessment and Diagnosis expectation that counselors accurately recognize and differentiate mental disorders when formulating diagnoses and treatment plans.

Within the Intake, Assessment and Diagnosis work behavior area, counselors are expected to systematically gather sufficient, relevant information before arriving at a diagnostic conclusion. Observations from an initial contact—such as disheveled appearance, confusion, rapid speech, agitation, and paranoia—are important, but they are only part of a complete assessment.

An appropriate diagnostic next step is to obtain additional information (Option A). This includes:

Conducting a more thorough mental status examination.

Gathering history of present illness, psychiatric history, medical history, and substance use history.

Exploring onset, duration, and course of symptoms.

Considering differential diagnoses, including mood disorders, psychotic disorders, substance-induced conditions, and medical causes.

The NBCC-aligned counselor work behaviors in this domain emphasize:

Avoiding premature diagnostic closure.

Using multiple sources of information (client report, observation, records, and collateral sources when appropriate).

Integrating behavioral observations with history and contextual factors before assigning a diagnosis.

Why the other options are not the best diagnostic next step:

B. Establish a safety plan – Safety planning can be crucial, but it follows from a formal risk assessment (e.g., suicidality, homicidality), which has not yet been described. It is an intervention step, not the immediate next step in making a diagnosis.

C. Discuss the client’s addiction problem – No information has been presented that confirms a substance use disorder; assuming this would violate the expectation to base diagnosis on adequate assessment data.

D. Seek a 72-hour hold on the client – Involuntary hospitalization requires clear evidence of danger to self, danger to others, or grave disability. The scenario only notes symptom presentation; a more complete assessment (Option A) is required before considering such action.

Thus, the response that best aligns with NBCC’s expectations for competent diagnostic practice is to obtain additional information before forming or finalizing a diagnosis.

Career work with clients in midlife and later adulthood must consider actual life circumstances, including financial responsibilities, health, caregiving roles, retirement timing, age discrimination, and existing skills. For this reason, career counseling for this group should be grounded in the realities of clients’ lives—their current roles, constraints, and opportunities—making Option C the best answer.

Option A (focus on career selection) is more appropriate for adolescents or emerging adults choosing an initial field, not individuals who already have extensive work histories.

Option B (abstract self-perception) is too vague and detached from the very concrete life factors often central in midlife/older transitions.

Option D (emphasize training/education) may be appropriate for some clients, but it is not a universal guiding principle and ignores many who may not have the time, resources, or interest for extensive retraining.

NBCC Counselor Work Behavior Areas highlight that, in career development, counselors must integrate developmental stage and real-world context into their clinical focus, particularly for adults navigating later-life work and retirement decisions.

Behavioral approaches are grounded in the assumption that most human behavior, including maladaptive behavior, is learned through principles such as conditioning, reinforcement, modeling, and environmental contingencies. From this perspective:

Problem behaviors are acquired in the same way as other behaviors (through learning).

Therefore, they can be modified or unlearned using the same learning principles.

Option B directly reflects this core assumption.

A is inaccurate because behavior therapy typically focuses directly on observable behavior, not on uncovering deep “underlying causes” in a psychodynamic sense.

C is the opposite of what behavior therapy proposes; behavior therapy is built on the idea that learning principles are effective in changing behavior.

D is incorrect because behavior therapy uses many techniques (e.g., exposure, systematic desensitization, skills training, reinforcement strategies) tailored to specific problems and clients.

Understanding major theoretical orientations, including behavior therapy and how they conceptualize the development and modification of maladaptive behaviors, is part of the Areas of Clinical Focus within the Counselor Work Behavior Areas.

In the Counseling Skills and Interventions domain, family counselors are expected to explore interactional patterns and multigenerational influences to understand how families function as systems. Discussing extended family behaviors helps the counselor and family members:

Identify repeated patterns of interaction and expectations across generations.

Understand implicit rules, roles, and norms that guide behavior in the family system.

Recognize how these norms influence current conflicts, alliances, and communication styles.

This directly aligns with:

D. clarify familial behavior norms.

Why the other options are less accurate:

A. trace the origins of inappropriate behaviors – while understanding patterns over time may shed light on how certain behaviors developed, the primary systemic focus is on current norms and patterns, not on blaming or pinpointing an “origin.”

B. determine who else should be in counseling – extended family discussions may occasionally inform decisions about including others, but this is not the primary goal.

C. identify model family members – the purpose is not to label some members as “models” but to understand the overall system and its norms.

NBCC Counselor Work Behavior Areas emphasize that effective family counseling interventions involve examining family structure, patterns, and norms, including those influenced by extended family systems, to guide intervention planning.

In solution-focused brief therapy (SFBT), counselors emphasize:

Exceptions – times when the problem is less severe or not present.

Future-oriented, goal-focused questions.

Client strengths and what already works.

Option A, referring to exceptions, points directly to a hallmark SFBT technique: the counselor shows curiosity about when the problem does not occur or is reduced, helping clients identify what they are doing differently in those moments so they can build on those exceptions. (The stem’s wording about “prominent” is less precise, but “exceptions” is the key SFBT concept here.)

B. Miracle question labeled as an emotional-focused coping strategy mixes an SFBT tool (miracle question) with an inaccurate label; the miracle question is about imagining a preferred future, not simply an emotion-focused coping label.

C. Understanding issues within or outside of the client’s control is more characteristic of other cognitive or problem-solving approaches, not specifically SFBT.

D. In-depth views of distress is more consistent with insight-oriented or process-focused therapies, whereas SFBT de-emphasizes detailed exploration of problems and focuses instead on solutions.

NBCC Counselor Work Behavior Areas expect counselors to be able to apply interventions consistent with their theoretical orientation, and for SFBT that includes using exception questions, miracle questions, and scaling to help clients move toward solutions.

Within professional practice, counselors are expected to recognize how organizational environments can increase or reduce the risk of compassion fatigue, burnout, and impairment. An agency culture that discourages open discussion of stress, emotional impact, client crises, and critical incidents is an organizational risk factor for compassion fatigue.

A culture of silence means staff are less likely to:

Debrief after difficult cases.

Seek support or supervision when overwhelmed.

Normalize and process the emotional toll of their work.

This isolation can increase emotional exhaustion and secondary traumatic stress. Recognizing and addressing such organizational patterns is part of ethical responsibility to maintain counselor wellness and protect client care.

Why the others are incorrect:

B. Competition between agencies for resources is a systemic or macro-level pressure but is not, by itself, a direct internal organizational risk factor for compassion fatigue.

C. Predisposing personal characteristics and issues are individual risk factors, not organizational ones.

D. Providing required supervision and training opportunities is a protective factor, not a risk factor; supportive supervision actually helps reduce compassion fatigue.

This aligns with the NBCC Counselor Work Behavior Areas, which emphasize monitoring the impact of work settings on counselor functioning and advocating for healthy organizational practices.

When a client being treated for anxiety suddenly begins a new weight loss plan, the counselor’s next step should be assessment, not immediate endorsement or direction. Because changes in eating, exercise, and weight focus can be early signs of eating disorders, body image disturbance, or compulsive behaviors, the counselor should:

Explore the client’s motives, beliefs, behaviors, and emotions related to the weight loss plan

Screen for eating disorder symptoms, body dissatisfaction, compulsive exercise, and related concerns

Approach the topic from a weight-neutral, nonjudgmental stance, focusing on overall well-being rather than on body size or “good” vs. “bad” weights

That is exactly what Option C describes and aligns with the NBCC Counselor Work Behavior Areas for intake and assessment, where counselors are expected to gather sufficient, unbiased information before deciding on interventions.

Why the other options are less appropriate:

A. Affirm the client’s body size and health goals to meet the client where they are.While affirming the client and being supportive is important, automatically endorsing “health goals” framed as weight loss may inadvertently reinforce problematic or disordered patterns without adequate assessment.

B. Utilize behavior therapy to support the client in achieving new goals.Jumping into behavior-change techniques without clarification and assessment can miss a co-occurring or emerging eating disorder, which would be a serious clinical oversight.

D. Determine if weight loss is needed before responding.Deciding whether weight loss is “needed” is a medical determination and can reflect weight bias. Counselors are not charged with deciding if a client should lose weight; they are responsible for assessing psychological functioning and potential risk.

NBCC-aligned work behaviors emphasize ethical, non-pathologizing assessment, avoidance of bias (including weight bias), and careful screening for co-occurring disorders such as eating disorders.

In the assessment domain, counselors are expected to understand different forms of test validity and how they are established.

Content validity is based on a logical, rational match between test items and a clearly defined content domain (for example, a math test sampling the full range of skills taught in a course). The rationale is: does this set of items adequately represent the domain it claims to cover?

Construct validity is based on a theoretical rationale: the test is intended to measure an underlying psychological construct (such as depression, anxiety, or intelligence), and multiple forms of evidence (correlations, factor analysis, group differences, etc.) are used to support that claim.

Thus, the primary distinction is the nature of the rationale underlying the test (Option B):

Content validity relies on rational, expert judgment about content coverage.

Construct validity relies on theory and empirical evidence regarding how the construct should behave and relate to other variables.

Why the others are incorrect:

A. Nature of the judges: While expert judges are often involved in evaluating content validity, this is not the primary distinction; construct validity can also involve experts plus statistical evidence.

C. Types of items: The same items could, in theory, be examined for either type of validity; items themselves do not define the distinction.

D. Statistical analyses: Statistical evidence is especially important for construct validity, but simply saying “statistical analyses” does not capture the fundamental conceptual difference in rationale.

NBCC Counselor Work Behavior Areas expect counselors to use tests appropriately, which includes understanding these validity distinctions when selecting and interpreting assessment instruments.

The term “outsider witness groups” comes specifically from narrative therapy. In this approach, clients tell and re-author their stories, and selected others (outsider witnesses) listen to these stories and then respond by sharing what moved or resonated with them. This process:

Brings in social resources and supportive witnesses.

Strengthens the client’s preferred identity and alternative story.

Helps the client feel seen and supported in a broader community context.

Thus, option D. Narrative therapy is correct.

Adlerian therapy (A) uses family constellation, early recollections, and encouragement, but not outsider witness groups as a standard technique.

Gestalt therapy (B) emphasizes experiential awareness, here-and-now work, and empty-chair techniques.

Community psychology (C) incorporates social systems and resources but does not specifically use “outsider witness groups” as conceptualized in narrative therapy.

NBCC Counselor Work Behaviors expect counselors to know the distinctive concepts and methods of major counseling theories, including narrative therapy’s use of outsider witnesses to support client change.

When working with older adults in group counseling, counselors must adapt interventions and structure to the developmental stage, life circumstances, and typical perspectives of this population. Older persons often benefit from:

Clear structure and purpose in group activities

Concrete, goal-directed tasks

A sense of predictability and safety in the group process

Option A, increasing the use of purpose-specific, structured group activities, aligns well with these needs and is consistent with best practices for group work with older adults.

B is inappropriate: pre-group screening is especially important with older persons to consider cognitive, emotional, physical, and interpersonal factors and to ensure appropriate group composition.

C overemphasizes developing new interpersonal skills; while growth is possible and important, many older adults bring extensive life experience, and group work often focuses more on support, coping with transitions, loss, health changes, and life review than on entirely new humanistic skill sets.

D is contrary to established practice: personal reminiscence and life review are often highly therapeutic and developmentally appropriate for older adults, and should usually be supported, not avoided.

Therefore, the most appropriate action for a counselor is to increase structured, purpose-specific activities, making A the correct answer.

When a client brings up assisted suicide, the counselor is dealing with a situation that involves serious ethical, legal, and clinical considerations. The NBCC Counselor Work Behavior Areas emphasize that counselors must know and follow applicable laws, adhere to ethical standards, and seek supervision or consultation when facing complex or high-risk situations.

The best first step is Option A: seek professional and legal consultation/supervision. This helps the counselor clarify:

Legal requirements in their jurisdiction regarding assisted suicide.

Ethical obligations related to client safety, autonomy, and confidentiality.

Appropriate clinical responses and documentation.

Option B (maintain confidentiality) is important but not an action step and may need to be reconsidered if there is clear risk of self-harm. Option C (inform the family) could violate confidentiality without proper legal/ethical grounding. Option D (review palliative medications) is outside the counselor’s scope. Consulting first allows the counselor to proceed in an informed, ethical, and legally sound manner.

Career development theories (e.g., trait-factor, developmental, social-cognitive, constructivist) are tools that help counselors organize information about clients and their career concerns. They reduce the complexity of career issues by offering frameworks for understanding interests, abilities, values, developmental tasks, and contextual influences. This enables the counselor to select appropriate helping strategies, interventions, and assessments—making Option C correct.

Option A (increase job satisfaction and productivity) may be an indirect, long-term outcome of effective career counseling but is not the direct reason theories are useful to the counselor.

Option B implies theories “predict” a specific occupation; in reality, theories guide exploration rather than dictate a single occupational choice.

Option D suggests theories tell us what type of counselor is needed; career theories focus on client development and decision-making, not counselor classification.

NBCC Counselor Work Behavior Areas state that counselors should use theoretical models in their clinical focus to structure case conceptualization and intervention planning, and career development theories are precisely such frameworks in the career counseling domain.

Feminist counseling approaches highlight the impact of power, social roles, and systemic oppression on client wellness. These modalities place strong emphasis on social justice, advocacy, and empowerment, and they often extend beyond individual intrapsychic change to include action aimed at transforming oppressive systems that affect the client’s life.

Option A captures this core feature: feminist counseling actively orients intervention toward changing systemic threats (such as sexism, racism, heterosexism, and other forms of oppression) that harm the client’s mental health and overall well-being. This is consistent with counselor work behaviors that stress advocacy, attention to sociocultural context, and the integration of interventions that promote equity and client empowerment.

Why the other options are incorrect:

B. SFBT roots: Feminist therapy developed from feminist movements and critical perspectives on traditional psychotherapy, not from solution-focused brief therapy.

C. Contraindicated for couples and families: Feminist approaches are frequently applied to couples and family counseling, especially to examine power imbalances and gendered expectations.

D. Androgynous gender role requirement: While feminist therapy may explore gender roles and encourage flexibility, it does not require practitioners to “move beyond an androgynous gender role” as a precondition for effective practice.

This aligns with NBCC Counselor Work Behavior Areas, which include using counseling models that acknowledge social, cultural, and systemic influences and incorporating advocacy and systemic change into interventions when appropriate.

At the end (termination) of counseling, the key research and evaluation task is to determine what changed as a result of the counseling process. This is called outcome evaluation. It looks at whether client goals were met, symptoms decreased, or functioning improved.

Needs assessment (A) is done before services begin to determine what services or programs are needed.

Formative evaluation (B) focuses on ongoing feedback during the counseling or program to improve it while it is happening.

Program development (D) is planning or revising services, typically done before or between implementation phases.

NBCC-related work behaviors emphasize that counselors should be able to evaluate the effectiveness of their services and use that information ethically to improve practice. That is exactly what outcome evaluation does at termination.

In the Professional Practice and Ethics domain, counselors are expected to understand basic research concepts so they can evaluate the quality of studies and apply findings responsibly. When a researcher examines factors such as:

History (events occurring between pretest and posttest),

Differential mortality (attrition of participants from groups),

Pretesting procedures (testing effects),

Statistical regression (regression toward the mean),

they are evaluating threats to internal validity.

Internal validity (Option C) refers to the degree to which changes in the dependent variable can confidently be attributed to the independent variable, rather than to extraneous or confounding factors. Examining these threats is central to determining how well the experimental design supports cause-and-effect conclusions.

Why the other options are incorrect:

A. Content validity – Concerns whether a measure adequately samples the domain of content it is supposed to cover (e.g., whether a test of math skills adequately represents the math curriculum), not the design’s vulnerability to history or mortality threats.

B. External validity – Involves the generalizability of findings to other populations, settings, and times, not the internal threats listed.

D. Construct validity – Refers to whether a test or procedure actually measures the theoretical construct it purports to measure, not the impact of history, testing effects, or attrition on experimental outcomes.

NBCC-aligned counselor work behaviors emphasize that ethically responsible practitioners must be able to critically evaluate research methods, including recognition of internal validity threats, to determine how much confidence to place in study results they might use to inform practice.

In Donald Super’s career development theory, career maturity refers to a person’s readiness to successfully complete the career-related tasks appropriate to their developmental stage. This includes:

Making realistic career decisions at that stage.

Possessing attitudes and competencies needed for age-appropriate career exploration and choices.

Thus, career maturity (C) is the concept that explicitly focuses on completion of appropriate tasks at each developmental stage.

A. Self-efficacy refers to belief in one’s ability to perform tasks, but it is a broader construct (Bandura), not specific to Super’s framework.

B. Maintenance is one of Super’s life-span stages (maintaining one’s career status), not the overarching concept of task readiness.

D. Crystallization is a sub-stage where a person begins to clarify and firm up a vocational preference, but it is only one part of the broader picture.

In the NBCC Counselor Work Behavior Areas, understanding career development theories and tasks across the lifespan is a core clinical focus for career counseling.

When assessing intellectual disability, severity is determined primarily by adaptive functioning, particularly in conceptual, social, and practical domains, rather than by etiology or isolated mental status features. For a seven-year-old, the counselor would consider how the child:

Understands and uses concepts (e.g., time, quantity, basic academic skills).

Solves problems and learns new information appropriate to their developmental level.

Option D. Concept formation aligns with this focus on conceptual functioning, which is central to determining the severity of intellectual disability.

A. Pressured speech and B. Agitation are more associated with mood or anxiety disorders (e.g., mania, acute distress) rather than severity of intellectual disability.

C. Genetic factors may help explain the cause of the disability but do not determine its severity.

The NBCC Counselor Work Behavior Areas emphasize accurate use of diagnostic criteria and understanding that severity ratings for intellectual disability are based on everyday functioning in key domains, not just on symptoms or etiology.

The counselor’s role in intake and assessment includes identifying symptom patterns, duration, and functional impairment to form a preliminary diagnostic impression. Persistent and excessive worry occurring for at least six months, accompanied by symptoms such as muscle tension and difficulty concentrating, is characteristic of Generalized Anxiety Disorder. Counselors must evaluate duration, symptom clusters, and context to differentiate GAD from other anxiety- or stress-related conditions.

In the Counseling Skills and Interventions domain, counselors are expected to use basic attending and responding skills to facilitate understanding, rapport, and client growth. One of the core skills is reflection.

Reflection involves the counselor restating or paraphrasing the client’s message, often focusing on feelings and meanings, using the counselor’s own words while staying close to the client’s experience. Reflection may:

Clarify what the client is expressing

Highlight underlying emotions

Help the client feel heard and understood

Bring important themes or aspects into focus

In the scenario, the counselor is:

Restating the client’s concern using different words

Including possible emotions and relevant factors

This matches the definition of reflection (sometimes called paraphrasing with feeling), not the other skills.

Reframing (A) involves offering a new, alternative meaning or interpretation of a situation (changing the “frame” through which the client sees the problem), rather than simply restating it.

Confrontation (C) involves pointing out discrepancies, contradictions, or distortions in the client’s words, behaviors, or beliefs.

Summarization (D) is a broader pulling together of themes and content over a longer segment of the session or several sessions, not a single restatement of the presenting problem.

Therefore, the counselor is using reflection, making B the correct answer.

In intake and assessment, counselors are expected to recognize possible indicators of psychotic symptoms and to follow up with focused questioning. A report that “everyone is always speaking at once” suggests that the client may be experiencing perceptual disturbances involving hearing voices, which is characteristic of auditory hallucinations.

The counselor’s responsibility, as outlined in assessment-related work behaviors, is to:

Identify verbal cues suggesting hallucinations or other psychotic features.

Conduct further assessment to clarify the nature, frequency, and impact of these experiences.

Determine risk, functional impairment, and the need for referral or coordinated care.

Why the other options are incorrect:

A. Visual hallucinations involve seeing things (people, objects, lights) that are not present; the client’s description specifically involves “speaking,” which is auditory.

C. Delusions of grandeur are fixed false beliefs about having exceptional power, importance, or identity, not a perception that many voices are speaking at once.

D. Tactile hallucinations involve feeling physical sensations (e.g., bugs crawling on the skin) that are not actually occurring.

This is consistent with NBCC Counselor Work Behavior Areas, which emphasize accurate symptom recognition and diagnostic assessment as foundational to responsible counseling practice.

Behavioral counseling focuses on observable behavior, measurable change, and the systematic application of learning principles. When setting up a behavior change program, a behavioral counselor typically:

Establishes a baseline of behavior (Option A) to know the current frequency, intensity, or duration of the target behavior.

Uses contingency management (Option B) — arranging rewards, consequences, or environmental changes to increase or decrease behaviors.

Reviews previous research (Option D) to select interventions that are evidence-based and appropriate for the presenting concern.

Self-actualization (Option C) is associated with humanistic and existential approaches (e.g., Maslow, Rogers), focusing on personal growth and fulfillment rather than directly on observable behavior and contingencies. While a counselor may value growth in a broad sense, a behavioral counselor does not need to directly work from a self-actualization framework when designing a behavior change program.

NBCC Counselor Work Behavior Areas related to interventions highlight that behavioral approaches rely on empirically supported, observable, and measurable strategies, which makes self-actualization the least relevant concern in this specific context.

In the Counseling Skills and Interventions work behavior area, counselors are expected to select interventions that are supported by empirical evidence for the client’s specific concerns, including substance use disorders.

Motivational interviewing (MI) (Option A) is a widely researched, empirically supported treatment modality for individuals with substance use disorders. It is a client-centered, directive approach designed to:

Enhance intrinsic motivation for change,

Resolve ambivalence,

Support clients in moving through stages of change regarding substance use.

Core MI skills often summarized as OARS (open questions, affirmations, reflections, summaries) are used to elicit and strengthen “change talk” and reduce resistance. Research has consistently shown MI’s effectiveness in reducing substance use and increasing treatment engagement across various populations and settings.

Why the other options are less appropriate here:

B. Narrative therapy – While potentially helpful for meaning-making and identity reconstruction, it is not the primary empirically validated front-line modality for substance use disorders.

C. Solution-focused brief therapy – Has some supportive evidence for various problems and can be useful in certain substance-related contexts, but MI has a stronger and more direct evidence base specifically for substance use disorders.

D. Eye movement desensitization and reprocessing (EMDR) – Primarily validated for trauma-related disorders, particularly PTSD, rather than as a core, primary treatment for substance use disorders.

NBCC-aligned counselor work behaviors emphasize that practitioners should match interventions to the problem using approaches with strong empirical support, making motivational interviewing the best choice among the options for treating substance use disorders.

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