There's interesting stuff going on with the narrative: the narrator is a scary eavesdropping creep. The story unfolds as he spies on a patient and her psychologist. So the literary-analysis part of my brain is ticking along and thinking Oh, wait, does this represent the reader? Always poking into other peoples' business, wondering what happened? Later on, the narrator interferes in the patient's life. Then that part of the brain wonders if the narrator more represents the writer—nudging the plot along when things look stuck.
Scary narrator is scary. He's even scarier at one point if you know your way around San Francisco. The object of his eavesdropping lives on Alpine Terrace... but scary narrator doesn't know where Alpine Terrace is. At one point, he ends up having to walk around... and he doesn't know he's walking around by Alpine Terrace, but if the reader does (perhaps due a The Genome Game's pregame puzzle) then there's a few paragraphs there of extra suspense.
But getting past the framing-device-literary stuff, the story within is interesting, too. It's set in the 1970s, so we can remember that overly-earnest political folks were annoying back then, too. And I learned some things about Jewish&Zionist politics right after World War II. I tend to like my novels bleak, and there was a motherlode of bleak hiding in there. Good stuff. Check it out.