What makes it difficult to help this type of narcissist is their self-deception. The processes used to protect themselves are ingrained from childhood. As a result, they are absolutely unaware of their constant efforts to maintain a viable "self." If they are meeting with success, they are satisfied with life regardless of whether the people around them are happy. Two circumstances bring this type of person to a therapist's office. Sometimes a partner who feels chronically unheard and unseen drags them in. Or, they have met with some failure (often in their career) so that the strategies they previously used to maintain self-esteem suddenly no longer work. In the latter situation, their depression is profound--like cotton candy, their robust false self dissolves, and one is able to see an accurate picture of their inner sense of worthlessness.
Can such people be helped? Sometimes. The critical factor is whether they ultimately acknowledge their core problem: that as a child they felt neither seen nor heard (and/or their self was fragile as a result of trauma, genetic predisposition, etc.), and they unconsciously employed self-building strategies to survive. Acknowledging this truth takes much courage, for they must face their underlying lack of self-esteem, their exceptional vulnerability, and significantly, the damage they have caused others. Then comes the long and painstaking work of building (or resurrecting) a genuine, non-defensive self in the context of an empathic and caring therapy relationship.
A Note about Narcissism and Genetics: Is narcissism a genetic disorder?
(For other books on this topic, see Amazon link below)
The Narcissistic Family: Diagnosis and Treatment
by Stephanie Donaldson-Pressman and Robert M. Pressman. While
billed as a book for therapists, The Narcissistic Family: Diagnosis
and Treatment is clearly written and accessible to
non-professionals. There are many case examples and little
jargon. An excellent choice for those wanting to learn more about the
consequences of narcissism.
Trapped in the Mirror : Adult
Children of Narcissists in Their Struggle for Self
Psychologist, Elan Golomb, interviews adult children of narcissistic parents and describes her own attempts to undo the damage from her childhood.
Children of the Self-Absorbed : A Grown-Up's Guide to Getting over Narcissistic Parents Psychologist, Nina Brown describes the effects of having narcissistic parents, and offers suggestions on how to overcome the results of such an upbringing and regain a healthy sense of self.