This paper describes a qualitative research study which compared accounts from interviews with families where difficulties had evolved into serious problems with those where an escalation into pathology has been avoided. These accounts confirm that family life is commonly seen to be problematic and stressful, particularly during transitional stages. Specifically, it appears that it is not simply the severity of the initial stresses and problems that distinguishes families, but the meanings that these evoke and the corresponding patterns of responses, especially the 'attempted solutions' that are set in motion. These responses, fuelled by external interventions, can launch families along pathological pathways. It is suggested that the meanings ascribed to difficulties and the ensuing responses are predominantly shaped and constrained by three factors: the dominant societally shared discourses of mental health and distress; the emotional resources and attachments of family members; and systemic interpersonal processes. Some therapeutic implications, especially the importance of assisting families to resist pathologizing processes are indicated.