Objectives <p>The aims of our research were to explore how psychotherapists recognize and experience empathic distress (ED), investigate their self-regulation strategies used within and outside psychotherapy sessions, and explore the role of mindful awareness during sessions in relation to self-regulation and ED.</p> Methods <p>We employed a qualitative, grounded theory methodology. We conducted interviews with eight Slovenian female integrative psychotherapists.</p> Results <p>Therapists reported experiencing intense emotions and physical reactions during empathic distress (ED), including anxiety, irritability, apathy, self-critique, resistance to work, fatigue, and physical pain. Many described prolonged periods of unrecognized ED. We found that mindful body awareness, a decentered perspective, and co-regulating with the client within therapy sessions were significant self-regulation strategies for therapists. Therapists also emphasized the importance of self-regulation before and after sessions and the value of supervision. Mindfulness, other meditation practices, and socializing were highlighted as significant out-of-session regulation strategies for the prevention of ED.</p> Conclusions <p>This study highlights the critical need for psychotherapists to have tools for the early recognition of empathic distress. It introduces the Empathic Distress Prevention Model for Psychotherapists, emphasizing the role of mindful body awareness and other self-regulation strategies during therapy sessions, along with self-care outside of therapy. By addressing in-session self-regulation, rarely explored in psychotherapy literature, this study contributes novel insights with applications for therapists’ well-being, practice, education, and supervision.</p>