This article focuses on the relevance of attachment theory and research in the conceptualization and treatment of pathological narcissism. It is proposed that the relational context of individual development and the interpersonal interpretative capacities that emerge as part of the attachment system may be salient factors in the etiology and treatment of narcissism. Included is an overview of research on attachment models and their correlation to adult psychopathology and to narcissistic personality disorders. It is suggested that internalization and maintenance of a “secure base” and improvement in self-reflective functioning informs and enriches the clinical treatment of adults with narcissistic features.