The album features Dave's piano playing, while Smith assisted with Baroque influences, including strings, brass, harps, as well as more contemporary music through the use of drums and the synthesizer.

A concept album, Psychodrama follows the narrative of a therapy session, primarily detailing the impact of Dave's elder brothers' prison convictions, along with his struggles with mental health, strained relationships, and the tough social conditions that confront poor black youths.

[5] In a 2017 interview with NME, Dave revealed he was working on his debut album slated for a 2018 release, stating: "I know exactly how I'm going to make it and what I need it to be, I just need to find the time.

I was in the middle of working on Stormzy's Gang Signs and Prayer album and my friends Jack Foster and Benny Scarrs who manage Dave introduced us.

[8][9] An accompanying tour was announced days later, and the tracklist was revealed on 3 March, showing features from Burna Boy, Ruelle, and the then-incarcerated J Hus.

"[7] Expanding on the Baroque influences on the album, Smith said, "We knew from the beginning that we'd be drawing from a very wide musical palette of strings, brass, harps, and hard-hitting drums and synths.

Other themes include Dave's strained relationships, poor upbringing, his father's absence and the impact it had on him, and issues such as domestic abuse and racial inequality.

[28][19] For Complex, Natty Kasambala wrote that "For a record tackling such heavy subject matter, it's still shockingly listenable and by constantly moving through different paces it holds your interest", praising the album's lyrics, production and Dave's flow.

"[29] Alexis Petridis of The Guardian acclaimed Psychodrama with a perfect score, calling it "the boldest and best British rap album in a generation."

"[2] The Independent labelled Psychodrama as "one of the most thoughtful, moving and necessary albums of 2019 so far", complimenting the concept and lyrical content: "Tracks are at once astute and deeply personal in how they capture vignettes of everyday life and spin them into important lessons.

"[23] Dan-O of Freemusicempire wrote "He opens the album in a therapist[']s office getting personal right off the bat and giving you a setting that makes sense so you don't feel awkward.

"[31] Carl Anka of NME also awarded the album a perfect score, calling it a "masterpiece", "bold and thought-provoking", and "the kind of record that comes along only rarely.