With, To or At?

“Listening is being able to be changed by the other person.” –Alan Alda

Have you ever walked away from a conversation realizing that, although someone had been talking to you, you weren’t entirely sure you had actually been part of the conversation? I certainly have. You may have learned something. You may even have been interested in what they had to say. But somewhere along the way, you became less a participant and more an audience. They weren’t really talking with you. They were talking to you, or perhaps even at you.

Of course, we commonly use “talking to” and “talking with” interchangeably. But lately I’ve been wondering whether these tiny prepositions might help us notice something important about how we show up in conversation, not only with our patients, but also with each other. Talking at someone tends toward one-way communication: I have something I want you to hear. Talking to someone may be more responsive: I recognize your presence, listen, and respond, while still largely shaping where the conversation goes. Talking with someone introduces something different, called conversational reciprocity. I offer something and you respond. What you say influences what I say next, which influences what you say next. Together, we create a conversation neither of us could have created alone.

Research on conversation suggests this reciprocity matters. People who ask more questions, particularly follow-up questions, are experienced as more responsive: as listening, understanding, validating, and caring. Other research has linked these kinds of high-quality listening behaviors with greater social connection. Conversational reciprocity, however, isn't simply taking turns or dividing airtime equally. It is allowing another person's contribution to genuinely shape the conversation. Perhaps a simple way to notice the difference is to ask ourselves: Does what you just said change what I say next?

Ironically, passion and expertise can make this harder. The more we know, or the more deeply we care, the more we have to say. We explain. Elaborate. Add another example. Tell another story. Our enthusiasm may be genuine and our intentions generous, yet gradually questions become fewer and responses become launching points for what we wanted to say anyway. What feels to us like sharing may feel to the other person like being talked at. As I reflected recently in the blog Making Room for Disagreement,  another person's silence can easily be mistaken for agreement. Perhaps it can also be mistaken for engagement.

This week, pay attention to a few of your conversations with your PeerRx partner, other colleagues, family, friends, and patients. Note not just to how much you talk, but to what happens after the other person speaks. Do you find yourself waiting for an opening to say what you were already planning to say? Or does what they offer help shape where you go together? Conversational reciprocity doesn't require equal airtime. It simply requires that both people matter to what is being created. Perhaps that's the difference between talking at, talking to, and truly talking with. And when it comes to connection, that distinction makes all the difference.