Nearly two-thirds of the people who got counseling after the Sept. 11 attacks are still grieving, and more than four in 10 still need professional help to cope, according to a study sponsored by the American Red Cross.

A girl holds a photo of her uncle firefighter Sean Tallon, as her mother Rosaleen Tallon-Da Ros and Sally Regenhard, holding a photos of her son firefighter Christian Regenhard, listen to testimony during a committee hearing on the status of the redevelopment of Lower Manhattan and ground zero, Thursday, May 18, 2006 in New York. Firefighters Tallon and Regenhard died during the attacks on the Worl Trade Center. Officials rebuilding the World Trade Center site defended their progress Thursday to state lawmakers who asked why no office towers had risen at ground zero nearly five years after terrorists destroyed the twin towers. [AP]

The study, released Friday, evaluated counseling, health services and other aid the Red Cross Sept. 11 recovery program provided to thousands of family members, first responders and others directly affected by the 2001 attacks. It also surveyed 1,501 people who received Red Cross aid.

The Red Cross provided more than $700 million in assistance between 2002 and 2005 and has given about $90 million more since then to other nonprofit groups that will provide services for at least another year.

Forty-three percent of those surveyed said they still need therapy, financial aid to pay bills or other health services.

The executive director of the recovery program, Alan Goodman, said the survey proved that those who lost loved ones or escaped death on Sept. 11 may be permanently scarred.

For those who complained of post-traumatic stress disorder, he said recovery could take "many, many years if there is recovery, if ever."

Sixty-three percent of people who received mental health services after the attacks said that grief and anxiety interfered with their lives to a large or moderate extent, the study said.

About three-quarters of the people who sought counseling said it helped them, while two in 10 said they were unsatisfied, mostly because their aid didn't cover enough counseling sessions.

The Red Cross said it planned to stop all of its indirect aid to nonprofit organizations in the next year or two. One organization, the Mental Health Association of New York City, has received more than $15 million in Red Cross aid to counsel Sept. 11 survivors. Its programs are set to expire at the end of 2007.

About 12,000 people have enrolled since 2002, said Sanja Blazekovic, who coordinates Sept. 11 mental health benefits for the organization. She said that in the past six months, more civilians than first responders have enrolled, upset about press coverage about the trial of Sept. 11 conspirator Zacarias Moussaoui, rebuilding controversies and reports of a growing number of ailing or dying ground zero workers.

The survey, prepared by the Washington, D.C.-based Urban Institute and Princeton Survey Research Associates International, was conducted by telephone between mid-July and mid-December in 2005, excluding a three-week period around the fourth anniversary of the attacks. The margin of error was plus or minus 3 percentage points.