Genres attributed to "God Only Knows" include baroque rock, baroque pop, art pop, psychedelic rock, avant-pop, and experimental pop. Brian Wilson has said that he wrote the song as an attempt to match the standard of the Beatles' Rubber Soul album, which was released in December 1965. In his recollection, he was under the influence of marijuana and was "so blown away" with the album that he sat at his piano and began writing the song.

The composition is known for its harmonic sophistication and extensive use of inverted chords, including third inversions such as B⁷/A. The first chord of the verse (D major/A) is a non-diatonic chord. The tonic chord (E major) usually only appears with the major 3rd or the 5th in the bass. The entire verse progression sounds restless and ambiguous, until the line "God only knows what I'd be without you" when the chord progression finally reaches a clear goal (A–E/G?–F?m⁷–E). This has been cited by musicologists as a good example of how lyrical meaning can be supported and enhanced by a chord progression—along with the melody hook which also provides an example of "a sense of increasing melodic energy that comes by way of the gradually ascending line". Stephen Downes similarly named the song's "tonal plasticity" emphasized by the disuse of authentic cadences and root-position tonics as the reason for its "expansiveness". In musicologist Philip Lambert's opinion, the song's vocal counterpoint evokes the sacred traditions of a cantata by Johann Sebastian Bach or an oratorio by George Frideric Handel. Andy Gill of the post-punk band Gang of Four describes the composition:

It's really very like the way classical music works, like a classical opera, say Lakmé by Delibes (the music that British Airways has appropriated). The melody rises and falls while the echo of that melody, sung by another voice, intertwines with it. Then it goes back to the verse, with its own melody, which is a variation on the chorus melody. As that is sung, the background voices provide an abstract, disconnected harmony. All the time, upfront, is the poetic heart of the lyric.

The key gravitates between A major and E major, while the bass-line was written in a different key from the rest of the song. The music theorist Daniel Harrison compared the song to an earlier Brian Wilson composition, "California Girls", as it both avoids a root-position tonic and suppresses a cadential drive. It also contains a step-wise descending bass-line like Wilson's other compositions on the Pet Sounds album. Dominic King believed the barbershop flat seventh saved the song from "excessive sentimentality".

After its instrumental linking passage, the key ascends to its fourth interval. According to author Jim Fusilli: "Brian came pretty close to writing himself into a dead end. There's really nowhere to go coming out of the bridge, which modulates to G major from D major but ends with a D major–A major–B minor pattern. Thus, when the song returns to D Major, it must do so from B minor, which is kind of a static change, particularly when the next chord is a B minor with only a slight variation in the bass." Along with the 8+4 measure verse/chorus scheme, Downes called the idea of a "bridge section in a related key" standard for rock/pop music, but adds: "What is different here, however, is how the move to the subdominant in the bridge conditions the tonal behavior of the entire song, which, though nominally in E Major, is characterized throughout by a tension between it and A major." The "choral fantasy" during this key change eventually concludes that "a clear sense has eluded us for the entire experience–that in fact, the idea of 'key' has itself been challenged and subverted", in Lambert's opinion.

The song closes with perpetual rounds, a centuries-old technique that was not normally heard in pop music of its time. According to Wilson: "I liked all those old songs that used rounds, like 'Row, Row, Row Your Boat' and 'Frère Jacques'. I liked rounds because they made it seem like a song was something eternal."

The song is told from the point of view of someone contemplating life without their lover, as Asher describes, "'I'll love you till the sun burns out, then I'm gone,' ergo 'I'm gonna love you forever.'" Wilson explained that "God Only Knows" was "a vision that Tony and I had. It's like being blind but in being blind, you can see more. You close your eyes; you're able to see a place or something that's happening." He initially hated the opening line of the song as "it was too negative." He eventually gave in after hearing the subsequent lyrics. In 1976, Brian said there was no one particular that the song was written for.

Fusilli extrapolated that the song was "a mature proclamation of love and a desperate plea. And it's a distillation of what much of Pet Sounds is about: the sense that if we surrender to an all-consuming love, we will never be able to live without it. And, though we're uncertain that the reward is worth the risk, we yearn to surrender." Fusilli also noted a closing phrase Wilson had once written to his wife in 1964: "Yours 'til God wants us apart." James Perone wrote: "While Wilson's character may indeed be in love with the woman to whom he sings, there is a hint that part of this 'love' may be self-serving and part of a cycle of codependency." Asher denied that the song alluded to suicide. He describes his interpretation:

This is the one that I thought would be a hit record because it was so incredibly beautiful. I was concerned that maybe the lyrics weren't up to the same level as the music; how many love songs start off with the line, "I may not always love you"? I liked that twist, and fought to start the song that way. Working with Brian, I didn't have a whole lot of fighting to do, but I was certainly willing to fight to the end for that. ... "God Only Knows" is, to me, one of the great songs of our time. I mean the great songs. Not because I wrote the lyrics, but because it is an amazing piece of music that we were able to write a very compelling lyric to. It's the simplicity—the inference that "I am who I am because of you"—that makes it very personal and tender.

"God Only Knows" is frequently cited for referencing "God" in its title,

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