During the final recording sessions at New York's Electric Lady Studios, additional guitar and bass overdubs were added by lead guitarist Micko Larkin and bassist Shawn Dailey, respectively.

The song was composed in tuning half a step down (E♭-A♭-D♭-G♭-B♭-E♭) and in its original form, which was twelve seconds longer than the final version, had heavy emphasis on piano, with the opening chords (Am-G-Dm-Am) being strummed on guitar in the background.

"[3] Entertainment Weekly described the song as "nakedly vulnerable" and "she [Love] mines something deeper — a girl who may still riot, but finally walks toward grown womanhood, too.

"[11] Pitchfork Media negatively compared to Hole's previous single "Pacific Coast Highway" as it was "filtered through years of overwrites and third-party input" and "suffers from a silly conceit, but offers moments of genuine humility.

[13] Courtney Love debuted "Letter to God" live during a guest performance with Linda Perry at the House of Blues in Los Angeles, California on June 1, 2007.

The song was also performed at the remainder of Love's 2007 live performances, which featured dates in Europe and the United States,[14] and featured Micko Larkin on lead guitar, Patricia "Pato" Vidal on bass,[15] future Hole member Stu Fisher on drums and percussion[16] Bethia Beadman on piano and keyboards, and rhythm guitarist Liam Wade.