Background: Previous research suggests that physiotherapists frequently engage with patients who experience psychological distress (e.g. feelings of depression and anxiety) and that physiotherapists find supporting these patients challenging. Objective: The aim of this study was to explore the experiences of Australian physiotherapists with patients they perceived were experiencing psychological distress. Methods: A ‘Big Q’ qualitative research approach was used. Twenty interviews with physiotherapists were conducted. The data were then analyzed using iterative thematic inquiry. Results: The analysis produced four interrelated themes: 1) encounters with patients in distress are common and varied; 2) becoming emotionally attuned with their patients meant that distress could invoke empathetic distress; 3) physiotherapists use emotional shields to protect themselves; and 4) physiotherapists found frequent encounters with patient distress to be emotionally exhausting. Viewed together, the themes highlight how patient distress can invoke transient empathetic distress in a physiotherapist; repeated experiences of empathetic distress may lead to empathetic distress fatigue. Conclusion: While physiotherapists are sometimes viewed as ‘physical’ health professionals, the experiences of these physiotherapists suggest that patient psychological distress is highly relevant to physiotherapy practice. We recommend future research explores the relationships between patient distress, physiotherapists’ empathy, and physiotherapists’ wellbeing.