Interventional psychiatry employs neuromodulatory and specialized treatments for refractory illnesses, including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and esketamine or IV ketamine. Referring practitioners and patients alike may have overvalued or fearful expectations of these interventions, which play out in the consultation process and throughout the treatment course. The interventional psychiatrist must also consider the structural barriers to accessing care, the primary relationship between the patient and referring provider, and the complexity in assessing outcomes in this treatment-resistant population.