Tammy Nelson is candid when she refers to her “mother issues.” She talks about them naturally and with great humor, but they’re definitely there… and no wonder. “My mother told me every problem she ever had in her life was because of sex,” Tammy confides at the start of our conversation. “And she told me this when I was six years old!”

I chuckled. Interviewing Tammy was wildly refreshing. I had no idea how funny and candid she was going to be recounting her own history and her work.

How It All Began

Today, Nelson is among the leading experts on sex and relationships. She offers a plethora of modalities to integrate them into therapy. She writes, hosts webinars and workshops, trains therapists, has a podcast, and still sees clients. It’s almost like she was born to do this. “I’ve been a therapist since I was a little kid,” she says with a laugh. “We were all latch-key kids. Schoolmates came to my house and told me their problems. Instant group therapy!”

Eventually, she decided to go into social work. “I was going to save people,” Nelson recalls. “I was seeing battered women. I was working in shelters.”

She moved on from social work to legal work, where she could do good and live more comfortably. But the night before her boards she suddenly realized that if she became a lawyer, she would be giving up too much. “I was an artist with work in a co-op gallery,” she says. “I would never paint again. So, instead I got a Master’s in art therapy, and that was the beginning of a million compulsive degrees!”

The Marriage of Sex and Couples Counseling

Tammy pulled everything she learned into a fascinating marriage of sexuality and coupledom in counseling. She believes in the absolute necessity of addressing sexuality as an integral part of couples therapy.  So, it makes sense that Tammy’s career involves teaching others that “sex is not the problem,” as she told me, “but it’s most likely the solution to most relationship issues.” Hearing that was a relief to me since one of my specialties is working with couples, and I suspect other couples therapists may feel reassured knowing this.

Integrative Sex and Couples Certification Training with Tammy Nelson

She posits there’s a search for both pleasure and power in people’s lives, but especially in women, where that need is “sort of shut down.” Sex can be a way for women to reclaim power and agency, as long as they’re owning their pleasure and not going through the motions to please someone else.

The connection between relationships and sexuality is always at the forefront of her work, and she’s frustrated that more training programs aren’t aware of it. “In all my years of training,” she says, “they never talked about sex. Even in medical school there’s about fifteen minutes of training on how to have conversations about sex. I find that fascinating because we’re all sexual people. We’re looking for relationships—getting one, getting over one. Sex is central to who we are. As therapists, we have a huge responsibility to know how to do it, how to talk about it, and help people with it.”

The Problem with Sex?

Too much in the area of couples’ therapy, Nelson feels, neglects the reasons people are having problems with their sexual expression and/or sex life together. “The immobilizing fear that follows trauma is a major reason both individuals and couples to seek relationship counseling and sex therapy,” Nelson asserts. “Yet most health professionals lack the training and supervision to help clients re-energize and reconnect with their authentic sexual selves.” She urges other mental health practitioners to become more familiar with the results of trauma and neglect, which must be dealt with before the couple can move on.

Nelson notes an increasing interest in exploring other modes of relationships, and she wrote the book Open Monogamy. “So many people say, ‘Do we have to have an affair to create a more flexible relationship agreement?’ Monogamy is no longer a simple concept,” she says. “More couples every year are experimenting with open relationships and newer, more flexible versions of commitment … yet few of us have been prepared with the skills we need to make those agreements work.” The book is for couples who wish to explore new directions in their relationships―to bring in excitement, variety, and fresh experiences without sacrificing trust, security, and respect. It’s not a black-and-white issue. Nelson helps couples find their place on what she calls the “monogamy continuum,” have honest conversations about attraction and desire, remove shame and suspicion from an open relationship, and create agreements―traditional or otherwise―that are fulfilling.

As a gay therapist who works with many gay couples, it is refreshing to hear how comfortable she is speaking about a continuum regarding monogamy.  This isn’t always the case while consulting with couples therapists. She affirms that the gay male community has led the way in examining different ways of being sexual in relationships. “Straight couples are just learning how to work things out now,” she admits. I pointed out from my own experience as a therapist that some professionals have puritanical views about open relationships, which isn’t helpful, and Nelson agreed. “There’s definitely a lens people look through when they treat clients,” she responds.

It’s also clear that younger people look at relationships and sexuality in general differently from those who are over 40. “Young people don’t want any kind of label,” Nelson says. “And they don’t want to have to educate us about it!” Maybe that offers hope for a more relaxed future, at least for some people. The issues around gender nonconformity, sexual orientation, and basic identity are all considered “normal” by many in this cohort, and it augurs well for the future.

Turning the Conversation Around

There is a sense of delight Nelson projects when she’s talking, a feeling that she’s doing exactly what she’s meant to do and enjoying almost every moment of it. It’s not that difficult to see how sex guides us, but not addressing that elephant in the room curbs therapists’ ability to respond to clients in ways that are helpful. Nelson is undeterred: through her own practice, through her workshops and events, and through her writing, she is trying to turn things around.

Of all her accomplishments, she’s particularly proud of her book Getting the Sex You Want. “That book helped a lot of people,” she says. “I’m proud that I pushed against the resistance to those ideas.”

When I asked if she had parting advice for beginning therapists, her answer was immediate. “Do what you love,” she says, “because eventually the money does follow. That book brought me around the world and changed my life, because I really believed in it. I knew that it was important. So do what’s important to you. Be yourself. People need your voice!”

Rick Miller

Rick Miller, LICSW, is an internationally recognized inspirational speaker, psychotherapist, and author. He is a pioneer in creating mind/body and hypnotic scripts for gay men, has trained medical and mental-health providers in creating and using them, and wrote the first-ever book on the topic. He is the founder and executive director of Gay Sons and Mothers, a nonprofit organization providing education around the powerful influence mothers have on their gay sons. He’s also created a series for clinicians, Secrets of the Masters, in which he interviews noted authorities in informal settings.

Tammy Nelson

Tammy Nelson, PhD, is an internationally acclaimed psychotherapist, Board Certified Sexologist, Certified Sex Therapist and Certified Imago Relationship Therapist.  She has been a therapist for 35 years and is the executive director of the Integrative Sex Therapy Institute.  She started the institute to develop courses for psychotherapists as the need grew for certified, integrated postgraduate sex and couple’s therapists in a growing field of mental health consumers who need more complex interventions for their relationship needs. On her podcast The Trouble with Sex, she talks with experts about hot topics and answers her listeners’ most forbidden questions about relationships. Dr. Tammy is a TEDx speaker, Psychotherapy Networker Symposium speaker and the author of several books, including Open Monogamy: A Guide to Co-Creating Your Ideal Relationship Agreement (Sounds True, 2022),  Getting the Sex You Want: Shed Your Inhibitions and Reach New Heights of Passion Together (Quiver, 2008), the best-selling The New Monogamy: Redefining Your Relationship After Infidelity (New Harbinger, 2013), When You’re the One Who Cheats: Ten Things You Need to Know (RL Publishing Corp., 2019), and Integrative Sex and Couples Therapy (PESI, 2020). Learn more about her at www.drtammynelson.com.