I hear the word Narcissism batted around a lot in professional quarters these days... to the point that it becomes as meaningless as other diagnostic terms and conditions that become short hand for ways to "professionally" legitimize stigma and excuse an inability to make an impact on someone whose control over their own life looks haphazard and self destructive and resists change and "advice" offered by professionals who do that sort of thing.
For me it seems important to remember that people who have strong narcissist leanings... I mean the real ones... not just vested and assertive self interest or differences of viewpoint that are unpopular in the group think tank... have inadequate ego strength usually because of trauma or sustained and unrelieved loss. Their "self" is like an egg shell of necessary bravado that is presented to the world because they feel without it their real self, inside the shell, will never be able to hold together or be put back together again should the shell crack or be cracked. A Humpty Dumpty kind of thing.
Most people in treatment who are defined in this way are failed by and subsequently repulse helpers who act like “all the king’s horses and all the kings men”. They’ve got all the equipment, the armor and weapons, but none of the finesse or skill. Lots of advice, none of the authentic listening skills and ways to give the person control of the rate of their own change and its dynamics. One can’t just take away a defense system even if it is defective. One can’t expect a hardboiled egg in two minutes. I think they, those helpers, also see themselves and their own narcissistic shell represented and it repulses them… and the more they fail to make impact the more it challenges their own narcissism.
A softer and more proactive approach is required here, a kinder one I think, with the understanding that the softness inside is vulnerable to the point of being unformed (or its vulnerability creates a terror of being unformed); but it is also the place where the heart is and it is generally tougher than supposed.
-- Bob Vance