So when a client comes into my office to talk about their issues, I am there for that client. If they bring their parent in for relationship counseling, I'm still there for my client. If a couple come in together as a partnership, I'm there as the advocate for the relationship, a facilitator and (sometimes) an umpire. Personally, ethically, I will not take a parent and child as separate clients, just because keeping their advocacy separate is significantly more work, and more like an exponent or order of magnitude than just a doubling. But when a client is there, and their parent isn't my client, I cannot make a diagnosis of that person. All I can say is "their behavior is consistent with X, so we can use that as a frame of reference, but it is not a diagnosis." And thus, we use the colloquial words, because we're trying to frame something. This is a practical matter of how therapy works, and yeah, that doesn't show up in the literature, because that's what we teach in practical education. It's one of those professional tricks, like when a GP breathes on the stethoscope to warm it before applying it to bare skin. You're never going to find that in the literature.
It's not that a narcissist has it better than someone with a diagnosis, anymore than someone who hasn't noticed a lump is better off than someone with a cancer diagnosis. A narcissist is still a bundle of insecurities. They're still stuck in a developmental fault state, where they don't actually fully accept or recognize that the world is full of other people with perspectives and agency. They're still desperate for attention, and craving approval, while simultaneously disbelieving that all of those figments of their imaginations can give attention and approval. They're profoundly lonely and disconnected from both their own ability to cope with their emotional reactions and control their internal needs. In many ways, they're worse off, because they have no means of dealing with their negative behaviors nor of understanding them. But they also don't know what's wrong, and they often don't think there is anything wrong, because other people don't fully exist for them, and if those figments complain, well, they're figments. How much can their opinion actually count?
Given a choice, on a personal level, I would much rather work with someone with an NPD dx than someone who displays behavior consistent with. Even if the person with the dx is still not convinced that we other people in their universe actually exist, they're willing to entertain the notion and are working the process, and usually will behave (however mechanically) as if we non-player characters are actually PCs. That is rarely true with narcissists, and they don't even realize they're discounting the rest of us.
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