The aim of this paper is to discuss selected theoretical concepts of narcissism, with particular emphasis on its subtypes, the characteristics of narcissistic pathology, and the possibilities and limitations of psychotherapy when working with this group of patients. Special attention is given to the distinctions between narcissism and borderline personality organization, as well as the complexity of malignant narcissism, which often marks the boundary of therapeutic effectiveness. The article employs a qualitative approach, combining theoretical analysis from the field of psychodynamic psychotherapy with a clinical case study, allowing for an in-depth reflection on diagnostic and therapeutic challenges. The findings indicate that, in work with individuals exhibiting narcissistic and antisocial personality structures, the primary therapeutic goal is not full personality reconstruction, but rather harm reduction and improvement of daily functioning. Supportive interventions may help mitigate destructive behavioral patterns, although they do not lead to deep structural change.