Eight sessions, no change: what the NCE says you owe a client who is not improving.
Four options: keep going, refer, revise, discharge. One item on what to do when the plan is not working, and the principle behind it that shows up in a dozen other items.
By Dr. Andrew Wichterman · September 22, 2026 · 6 min read
A client has attended eight sessions with no measurable change on the PHQ-9. The item asks the counselor's BEST next step and offers continue the same plan, refer the client to another counselor, review the case formulation and revise the plan collaboratively, or discharge the client as not benefiting. The third is keyed.
The practice item discussed here was written for this site in the style of the NCE. It is not a question from the actual exam. NBCC does not release its items, and candidates sign a nondisclosure agreement.
What the item is really testing
Treatment planning on the current exam is a loop, not a document. Assess, formulate, plan, intervene, measure, and when the measure does not move, return to the formulation. Six to eight sessions without progress is the conventional signal to do that. The counselor asks whether the problem was understood correctly, whether the objectives fit, whether the intervention matches the problem and the client, and whether something outside the room is blocking the work. Then the plan changes, with the client, and the change is documented with its reason.
The item uses a measure on purpose. The PHQ-9 makes "no change" a fact rather than an impression. Routine outcome monitoring, a brief measure every session or few sessions reviewed with the client, is how the counselor knows at session eight rather than session twenty. The exam tests that idea directly in other items; here it is the premise.
Why the distractors tempt
Continue tempts because change takes time, and sometimes it does. The exam draws the line at persisting unchanged with no data supporting it. Refer tempts because it sounds like humility, but referral before revision skips a step: the counselor has not yet tried a different approach with a client who is engaged and attending. Referral is right when the client's needs exceed the counselor's competence or a different level of care is indicated, not as the first response to a plateau. Discharge tempts no one who reads it carefully, but it is the extreme-response distractor the exam always includes, and discharging a client for lack of progress without discussion or referral approaches abandonment.
The pattern: the measured, collaborative option beats both persistence and exit. That rule decides more treatment-planning items than any other.
What the revision might be
Change the intervention: a client who has not responded to cognitive work may respond to behavioral activation. Change the dose: weekly to twice weekly for a period. Change the target: the presenting problem was low mood but the maintaining factor is untreated drinking or a marriage in crisis. Add something: a medication evaluation, a group, a case manager for the housing problem that is eating the client's energy. Change the level of care. Any of these is a revision. Quietly hoping is not.
Where this lives in the course
Domain 4, Treatment Planning, lesson 2: Barriers, revision and referral.
Check the current handbook. Exam logistics, fees and policies change. Confirm specifics against the NBCC candidate handbook and your state board's current rules. Aligned to the current NCE blueprint, valid for exams through June 30, 2027.
Not improving? Review the formulation and revise the plan with the client. Not persistence, not referral, not discharge. The measured option wins.