Four years have passed since the horror of 9/11. The Pentagon has been rebuilt. Physical wounds have healed. But the grief of those who lost loved ones, those who survived or those who tried to help is still raw.

In an interview with staff writer Brigid Schulte, three social workers at the Pentagon Survivors' Fund Project in Oakton described the suffering as a grief like no other.

QYour organization has counseled 11,000 people all across the country in the last four years. You're still helping 500 and will provide services until 2008. Why?

AStephanie Berkowitz, director: A lot of people think, "9/11 was four years ago -- people should be over it by now." But we have some people just now coming in who thought they didn't deserve help, like the first responders. And others who have been difficult to reach, like children. Children don't really understand the finality of death until age 8. So, if they were young when a parent died, their death may just now be affecting them, and it feels like it happened yesterday. For young people, especially as they go off to college, this is an extremely difficult time.

How so?

Andrea Zych, case management supervisor: Sometimes their parents are still not coping well, and the kids have to function in spite of that -- figuring out life, moving into a dorm, with a single parent who is still struggling or who may be very detached.

Meredith McKeen, group services and outreach manager: A lot of our clients are very tired of being identified as "9/11 kids." They don't want to be singled out. They wonder, "Does that mean I have to be sad and somber all the time in public? How am I supposed to act?"

Berkowitz: But maybe they're on a 9/11 scholarship and the schools inadvertently single them out.

McKeen: Or a well-meaning person arranges a ceremony. They can't escape it.

What are families and survivors dealing with now?

Zych: Some clients have done very, very well, and their cases have been closed. Others are still dealing with substance abuse, financial stress, overactivity, underactivity, depression, anxiety. Sometimes parents transfer their anxiety onto their children and become overly protective in the hopes of keeping them safe.

Berkowitz: Young children sometimes regress. Teens often act out and may not be able to name what is wrong. And some children blame themselves for what happened. One child associated going to work with dying.

McKeen: It's very common for couples to get in big fights. There's a high incidence of separation and divorce. Some people are suffering post-traumatic stress syndrome, not sleeping well. They'll see a low-flying plane or an ad for that new TV show about the Pentagon, and it brings it all back. They're telling us that they're just maxed out, that having to constantly cope with triggers like that is just exhausting.

What are other triggers?

Berkowitz: We had one young adult who was doing so well, she inactivated her case. Then within a year, she called and said she was getting married and she started having really sad thoughts about her dad, who perished in the Pentagon. It was a major setback for her, and she asked to come back in for help.

Zych: Getting married, the first child, graduating from school -- it hits hard: "Mom's not here."

Berkowitz: People lose people all the time, but for these kids, their parents were taken unjustly. There's an element of "My parents should be here."

Why do you consider this a different kind of grief?

McKeen: 9/11 was so violent and catastrophic that the grief is a traumatic grief. It affects you physically. It's something the brain can't make sense of. There's a general idea that everyone should be over it by now, but that comes from people's need for things to be fixable. Nobody is going to ever be completely healed. There's no such thing as getting over 9/11.