I think like a lot of men (especially white men) today he's struggled to find meaning in his life in part due to economic challenges we're all facing in the K shaped economy but also things like women doing better and not settling for the bar being on the floor meaning men have to do better.
I think he was getting attention from his local groups which led to getting attention from the consultants. I think that appealed to that feeling of belonging and being valued we all want.
I think he probably believes he was honest with himself and his team. But true honesty is really really hard. And it doesn't come from a couple of months of therapy. It comes from years of work and being willing to see your actions through someone else's eyes and not your own preferential interpretation.
Admittedly maybe I'm interpreting this through my own life, but that part feels very familiar to me. I didn't make the same types of mistakes in terms of drinking and mistreating partners, but I definitely did some stupid self harming things to try to be appreciated.
And to be honest, for all his flaws he's definitely got a talent for rallying people. So in that sense it's not ego. Yes some of his story was enhanced, but that's standard. Whether he would have been good in office isn't known, but skill in running is an important part of being a politician. If he started at a lower level and did more work on himself including making amends with his exes, maybe it's a different result.