The patient bemoans the girlfriend he dumped because he couldn't let her get too close. He berates himself as a loser who purposely fails in order to show his parents how badly they messed him up.

The therapist listens closely, humming "uh-huhs," and sometimes asks a question or makes a probing point. In a conference room at Massachusetts General Hospital, researchers watch the therapy session on video intently and score it using a set of 100 numerical ratings.

Did the therapist draw attention to uncomfortable emotions such as guilt or anger? Yes, a 9 out of a possible 9. Did the patient gain new insight? Not in today's session - a 2 on the 9-point scale.

Painstaking work like theirs, translating complex human interactions into hard data points, may be the last, best hope for saving what remains of Sigmund Freud - by showing that the style of deep, prolonged talk therapy he originated can work.

Freudian therapy rose early in the 20th century and reigned supreme for decades, dominating American psychiatry and permeating popular thinking with concepts like ego, repression, and the Oedipal complex. Psychoanalysts often developed years-long relationships with patients, delving into childhood memories, dreams, and hidden desires.

More recently, however, Freud's ideas have lost favor, and his style of therapy has fallen on hard times, victim of cost-conscious insurers and a focus on mental illness as biological brain disease. This decline has only been accelerated by many practitioners' insistence that what goes on between a therapist and a patient is too individual to lend itself to scientific research.

Left largely without studies demonstrating its positive effects, long-term talk therapy has been hard-put to justify itself to insurers, patients, and grant-givers. Treatment has shifted to drugs and quicker types of therapy with more evidence to back them up. They include cognitive behavioral therapy, which aims to change thinking and behavior in the here and now, and often lasts just a few weeks.

Of 650,000 therapists in the country, probably fewer than 200 make their living practicing traditional psychoanalysis, estimated Jonathan Engel, author of the new book, "American Therapy: The Rise of Therapy in the United States."

At Mass. General and elsewhere, researchers are ramping up a fight for long-term psychotherapy's survival, producing research that shows it helps some patients, and casts some light on how. One apparent finding: Just as the therapy lasts longer, it appears that its beneficial effects may often last longer.

The research efforts stem from the fear among practitioners that "we need to establish a new evidence base and wed better do it soon," said Raymond Levy, clinical director of the hospital's Psychotherapy Research Program.

In October, a review in the Journal of the American Medical Association supported longterm "psychodynamic psychotherapy" for patients with complex mental disorders. The review of 23 studies reported that in a pool of more than 1,000 patients, long-term psycho-dynamic therapy - lasting at least a year, or 50 sessions - was significantly more effective at relieving symptoms than shorter-term therapy.