Doctors and financial planners operate in different worlds, but they share a structural problem. Both work with something deeply personal: health in one case, money in the other. Both need honest disclosure to function. And both face the same pattern: people who understand and agree with the advice and don't follow it.
In the UK, between a third and a half of medicines prescribed for long-term conditions are not taken as recommended.[^National Institute for Health and Care Excellence. (2009). Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence (Clinical Guideline CG76). NICE.] Nearly a quarter of investors go against their adviser's recommendations.[^ Scottish Widows. (2025). The advice gap: Client and adviser perspectives. Scottish Widows.] The disclosure picture is similar. Between 61% and 81% of patients withhold information from their clinicians that is relevant to their care.[^Levy, A. G., Scherer, A. M., Zikmund-Fisher, B. J., Larkin, K., Barnes, G. D., & Fagerlin, A. (2018). Prevalence of and factors associated with patient nondisclosure of medically relevant information to clinicians. JAMA Network Open, 1(7), e185293.] In financial planning, a third of those who went against their adviser's recommendations had withheld information the adviser couldn't factor in.The clinical research is clear on why: fear of being judged and not wanting to be lectured are among the most consistently cited reasons. US research into financial planning suggests something comparable operates there too — embarrassment and not wanting to hear the adviser's response if they had the full picture.[^Hall, M. (2013, August 21). Clients withhold critical information from their financial advisors. Financial Planning.] Whether the domain is health or money, the barrier is rarely a lack of understanding. It is something closer to a lack of readiness.
What produces this pattern across two professions, in two different domains, with two different kinds of expertise at stake? There are many contributing factors but one candidate sits in something both professions share — not a skill gap, not a trust deficit, but a particular kind of ambivalence that both profession's dominant models may unintentionally aggravate.
Ambivalence, in the psychological sense, is something more specific than indecision or fence-sitting. It is the state of genuinely wanting two incompatible things at once.[^Reber, A. S., & Allen, R. (2009). The Penguin dictionary of psychology (4th ed.). Penguin Books.] The improved retirement outcome and the monthly income it would cost. The protection in place and the discomfort of contemplating what it is protecting against. The updated will and what writing it requires a person to confront. Both sides are real. The ambivalent client is not uncertain about the recommendation but caught between a future they want and a present they are not ready to leave. It is, in other words, a behaviour change problem rather than an information one.
The expert model
In financial planning, as in medicine, the dominant working model is roughly this: the professional has expertise the client lacks; the client has a problem the professional can solve; the professional's job is to assess the situation, identify the right course of action and recommend it clearly. When a client hesitates or fails to act, the model's response is to explain more clearly, present more compellingly, demonstrate the cost of delay in terms the client can feel. Resistance is treated as a comprehension problem. Sufficient clarity is supposed to eventually resolve it.
That logic holds when information is genuinely the barrier, and sometimes it is. When a client genuinely lacks information about the tax treatment of a pension, about the implications of dying intestate, about what their current savings rate will produce, better explanation produces better decisions. The expert model has its place.
But it was built for a specific kind of problem, and it assumes that information is the bottleneck. Most clients who haven't updated their will already know they should. Most who are underinsured are aware of it. When someone withholds information from a doctor or an adviser, it is rarely because they lack the relevant facts about why disclosure matters. The gap between knowing and doing is not, in most cases, an information problem. Information aimed at a non-information problem mostly produces better-informed inaction.
The righting reflex
In 1983, psychologist William Miller described a pattern he had observed in clinical settings and called the righting reflex.[^Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11(2), 147–172.] It is the trained impulse, strong in helping professions, to correct a problem when you see one: to argue for the right course of action, to resolve the tension, to close the gap between what a client is doing and what they ought to be doing. It is not a character flaw and in many situations it is exactly the right response. But in the presence of ambivalence it reliably produces the opposite of what it intends.
The behavioural mechanism is worth unpacking. Ambivalence, by definition, contains arguments on both sides. When a financial planner meets resistance with another projection, a remodelled cashflow, or yet another chart, the client may start making the case for doing nothing. Not because they have decided against the change, but because being pushed toward one position activates the arguments for the other. The client hears themselves making the case for staying put and in doing so, strengthens it. The adviser means well and is technically correct. The push is the problem. The harder the push, the more convincing the case for inaction becomes, at least to the person making it.
The alternative is not less expertise but a different kind. One where the technical recedes and the relational drives the conversation forward. The professional instinct is to push harder — yet a substantive body of research suggests the opposite direction tends to work better. Drawing out the client's own case for change, rather than making it for them, is the principle at the centre of motivational interviewing.
Motivational interviewing
Developed in clinical settings and subsequently extended across behaviour change domains, with a growing body of application in financial planning, it begins from a premise that inverts the expert model's central assumption. In motivational interviewing, the financial planner's job in the presence of ambivalence is not to resolve it through persuasion but to help the client hear their own ambivalence clearly enough to resolve it themselves. Miller and Rollnick describe it not as a technique but as a spirit, an orientation toward the other person that treats ambivalence as information rather than obstacle.[^Miller, W. R., & Rollnick, S. (2023). Motivational interviewing: Helping people change and grow (4th ed.). Guilford Press.] Three things follow from that in practice.
The first is that questions do different work than explanations in an ambivalent conversation. A question that invites a client to articulate what a change would mean for them, or what is making it feel difficult, surfaces the ambivalence rather than glosses over it. An explanation adds information to a situation where information is not the constraint. The distinction may sound small. In practice it changes the entire shape of the conversation.
The second is that the righting reflex needs to be actively resisted. Sitting with a client's hesitation without immediately moving to resolve it feels, within the expert model, like professional passivity. It is not. It is a different kind of work: creating the conditions for the client's own motivation to become audible rather than replacing it with the planner's.
The third is that both sides of the ambivalence deserve attention. A financial planner who only reflects the case for change back to the client is still steering. The MI-informed conversation explores the whole of it: what makes the change appealing and what makes it feel costly, difficult or premature. It is only when a client has heard both sides clearly, in their own words, that they are in a position to move through them.
What this looks like at the level of a single exchange is where most of the practical work happens. The shift from expert-model to MI-informed responding often comes down to a single conversational move, not a wholesale change in how a meeting is conducted, but a different response to a particular kind of moment. The interactive tool below takes the same client moment and shows where an expert-model response and an MI-informed one diverge, and why the difference tends to matter.
Interactive tool
The same moment, two different conversations
Client says
'I know we said I'd increase my contributions last time. I just haven't got round to it yet.'
'Let me show you the updated projections. If we increase your contributions by 2% now, the difference to your retirement income over twenty years is significant. Every month we delay makes it harder to close that gap.'
Client says
'The will is on my list, I promise. We'll sort it after Christmas.'
'I understand, but it really is important to get this in place. If something were to happen before then, your estate would pass under intestacy rules rather than your own wishes. It doesn't take long to set up.'
Client says
'Spending? It's roughly what we discussed. Maybe a bit more some months.'
'Let's go through the numbers. If spending is higher than we planned, it has a direct effect on how long your portfolio needs to last. I want to make sure we're working from accurate figures.'
A longer curve
Motivational interviewing is not therapy, and applying its orientation in a financial planning context does not require clinical training. Nor is this an argument against clear, direct advice. Much of what advisers do is straightforwardly informational, and the expert model serves those interactions well. The skill is in reading which kind of conversation is actually in the room.
The ambivalence signal is usually readable. It shows up as non-implementation after agreement, as 'yes, but not yet,' as the client who is present in the meeting and absent in the months between them. When that pattern appears, the question worth asking is whether more explanation is really what the situation calls for.
Medicine took decades to move from paternalistic prescription toward shared decision-making. The shift was not primarily technical. It was a change in the underlying conception of what the job is. Financial planning is at an earlier point on the same curve. The best adviser conversations have probably always had something of this orientation in them. Motivational interviewing does not invent it. It names it, grounds it in a coherent account of how ambivalence and change actually work, and makes it possible to do deliberately rather than only by instinct. That may be its most practical contribution: not a new technique, but a more precise language for something the best conversations in financial advice already contain.
