The interpretation of Psalm 23 in early Christianity was remarkably uniform. Christians in the third, fourth, and fifth centuries consistently interpreted this psalm as a proclamation and description of how God, the good shepherd, guides his sheep into his flock, the church. The allusions to “water” in v. 2 and to “table” and “cup” in v. 5 came to be seen as particularly significant for the interpretation of this psalm, linking it to the Christian initiation rites of baptism and the Eucharist. This interpretation, however, is not merely the result of allegorical or figurative exegesis, as is often assumed. Rather, the uniformity across the Christian world suggests that there is a more complex process at work. Drawing on recent developments within socio-rhetorical interpretation, specifically what is known as “visual exegesis,” I argue that patristic interpretation of this psalm is the result of the convergence between scriptural, cultural, and liturgical images in the Christian imagination. By attending to the cognitive dimensions of early Christian interpretation, I suggest, we can better appreciate early Christians’ theological engagement with Scripture.