Aims: Family counselling, with its preventative and supportive focus, could offer an important addition to higher intensity family therapy services, improving functioning for families in need. However, a basic question is whether families presenting to such services are, as assumed, less distressed than those presenting to National Health Service (NHS) services. This study therefore examined the levels of distress (child and family functioning) of families seeking help at a national voluntary sector family counselling service (Relate). In addition, the study explored how parents and children describe their families and understand the difficulties that brought them into family counselling. Method: A total of 54 families (60 adults and 15 children) from one local Relate centre completed the ‘Systemic Clinical Outcome and Routine Evaluation’ Scale (SCORE-15), the ‘Family Adaptability and Cohesion Evaluation Scale III’ (FACES-III) and the ‘Strengths and Difficulties Questionnaire’ (SDQ) before counselling. The answers to three open SCORE questions (family and problem description) were analysed with a combination of thematic and content analysis. Results: The quantitative results indicate moderate to high levels of distress reported by families when seeking Relate family counselling, comparable with NHS secondary service Child and Adolescent Mental Health contexts. The qualitative data show a broad range of problems at different levels (child-related issues, family conflicts, marital break-down and external pressure). Discussion: The results indicate a potential mismatch between the preventative and low-intensive focus of this kind of intervention and the levels of distress and problem severity in the help-seeking population. Possible implications from these results for further research and therapeutic practice are explored.