The psychiatrist Masterson has a great videotape demonstrating how he treats a narcissist vs. a borderline personality disordered patient. Once he accesses the guy's underlying grandiosity, he switches from confronting self-defeating behavior (as with a borderline) to reflecting and empathizing with the guy's underlying vulnerability. Over and over, every time he hears the grandiosity, he says stuff like "you must have felt vulnerable." "That's the kind of thing you say when you feel vulnerable." "That's like the last time you said that, when you felt defenseless and vulnerable." The narcissist is, at core, very afraid. It takes a long time, but it works....UNLESS....you're working with a narcissistic psychopath, which is a personality structure virtually incapable of attachment in anything other than a sadistic or dominating and controlling sense. They won't appreciate your attempts to access their underlying vulnerability, and will wish only to obliterate you. I work with a population of antisocial personality naricissists, and would very much appreciate any discussion on this matter.